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1 Clinical Management Service, "Alto Deba" Hospital, Mondragón, 2 Dept of Preventive Medicine and Public Health, Basque Country University, Lejona, and 3 Dept of Respiratory Medicine, Sleep Unit, Txagorritxu Hospital, Vitoria-Gasteiz, Spain. 4 Dept of Family Medicine & Community Health, Albert Einstein College of Medicine, New York, NY, USA. 5 School of Health and Related Research, University of Sheffield, Sheffield, UK
CORRESPONDENCE: J. Mar, Servicio de Gestión Clínica, Hospital "Alto Deba", 20500, Mondragón, Spain. Fax: 34 943 035314. E-mail: jmar@hmon.osakidetza.net
Keywords: cost-effectiveness analysis, Markov chains, obstructive sleep apnoea syndrome, quality of life
Received: May 17, 2002
Accepted October 25, 2002
This study was supported by the 2000 Commissioned Grant on sleep apnoea from the Basque Government Health Technology Agency (Vitoria, Spain) and Grant 01/0220 from the "Carlos III" Health Institute (Madrid, Spain).
The demand for diagnostic and therapeutic services for obstructive sleep apnoea syndrome (OSAS) showed marked growth during the 1990s. This paper analyses the long-term cost-effectiveness of nasal continuous positive airway pressure (nCPAP) treatment in comparison to conventional null treatment.
A Markov model was used to represent the natural history of OSAS based upon published evidence. Utility values came from a survey of OSAS patients. Data on health costs were collected from hospitals in the Basque Country, Spain.
The incremental cost-effectiveness ratio of nCPAP treatment is <6,000 Euros per quality-adjusted life year. On disaggregated analysis, nCPAP treatment accounts for 86% of incremental costs; 84% of incremental effectiveness is attributable to improved quality of life.
Treatment of obstructive sleep apnoea syndrome with nasal continuous positive airway pressure has a cost-effectiveness that is in line with that of other commonly funded treatments such as antihypertensive drugs. The key clinical benefit of nasal continuous positive airway pressure treatment is improvement in the quality of life of patients with obstructive sleep apnoea syndrome. This benefit is also precisely the one for which the evidence base is strongest. The remaining uncertainties concerning the impact of nasal continuous positive airway pressure on long-term mortality have only a relatively small impact on the economics of treatment.
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