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A bayesian cost-effectiveness analysis of a telemedicine-based strategy for the management of sleep apnea: A multicenter randomized controlled trial

Valentina Isetta, Miguel A. Negrín, Carmen Monasterio, Juan F. Masa, Nuria Feu, Ainhoa Álvarez, Francisco Campos-Rodriguez, Concepción Ruiz, Jorge Abad, Ramon Farré, Marina Galdeano, Patricia Lloberes, Cristina Embid, Mónica De la Peña, Javier Puertas, Mireia Dalmases, Josep M. Montserrat
European Respiratory Journal 2015 46: PA3376; DOI: 10.1183/13993003.congress-2015.PA3376
Valentina Isetta
1Unidad de Biofísica y Bioingeniería, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain
2Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
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Miguel A. Negrín
3Métodos Cuantitativos/ TIDES Institute, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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Carmen Monasterio
2Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
4Unidad del Sueño, Servicio de Neumología, Hospital Universitario de Bellvitge, IDIBELL, Hospitalet de Llobregat, Spain
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Juan F. Masa
2Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
5Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres, Spain
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Nuria Feu
6Unidad del Sueño, Hospital Universitario Reina Sofia, Universidad de Córdoba, IMIBIC, Córdoba, Spain
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Ainhoa Álvarez
7Unidad Funcional de Sueño, Hospital Universitario Araba, Vitoria-Gasteiz, Spain
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Francisco Campos-Rodriguez
8Servicio de Neumología, Hospital Universitario de Valme, Sevilla, Spain
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Concepción Ruiz
9Unidad del Sueño, Servicio de Neumología, Hospital Clínic, Universidad de Barcelona, Barcelona, Spain
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Jorge Abad
2Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
10Servicio de Neumología, Hospital Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
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Ramon Farré
1Unidad de Biofísica y Bioingeniería, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain
2Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
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Marina Galdeano
11Servicio de Neumología, Hospital Universitario Sagrat Cor, Universidad de Barcelona, Barcelona, Spain
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Patricia Lloberes
2Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
12Unidad del Sueño, Servicio de Neumología, Universitario Vall d'Hebron, Barcelona, Spain
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Cristina Embid
2Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
9Unidad del Sueño, Servicio de Neumología, Hospital Clínic, Universidad de Barcelona, Barcelona, Spain
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Mónica De la Peña
2Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
13Servicio de Neumología, Hospital Universitario Son Espases, IdisPa, Palma de Mallorca, Spain
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Javier Puertas
14Departamento de Neurofisiología Clínica y Unidad del Sueño, Hospital Universitario La Ribera, Alzira, Valencia, Spain
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Mireia Dalmases
2Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
9Unidad del Sueño, Servicio de Neumología, Hospital Clínic, Universidad de Barcelona, Barcelona, Spain
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Josep M. Montserrat
2Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
9Unidad del Sueño, Servicio de Neumología, Hospital Clínic, Universidad de Barcelona, Barcelona, Spain
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Abstract

Background: Compliance with CPAP therapy is essential in patients with OSA but an adequate control is not always possible. This is of clinical importance as CPAP reverses OSA morbidity and mortality. Alternative and more cost-effective approaches are needed. A telemedicine-based strategy could be of great interest.

Methods: One hundred thirty nine patients were randomized in a controlled trial that was performed to compare a telemedicine-based strategy for CPAP follow-up (patients' support based on a web platform support and videoconferences) with the standard face-to-face control. Main outcomes were CPAP compliance and cost-effectiveness (Bayesian analysis). Secondary outcomes: Quality of life (QoL), satisfaction and secondary effects questionaries.

Results: At six months, similar levels of CPAP compliance, improvement in sleepiness, QoL, side effects and degree of satisfaction were found in both groups. Despite observing more extra visits, the telemedicine group was more cost-effective: costs were lower and difference in effectiveness was not relevant.

Discussion: A telemedicine-based strategy for the follow-up of OSA patients under CPAP treatment proved to be as effective as the standard hospital-based care in terms of CPAP compliance and improvement. Cost-effectiveness analysis showed that the telemedicine-based strategy presented lower total costs due to savings on transport and indirect costs of productivity losses.

Funding: Supported by SEPAR/FIS PI14/00416. Supported in part by grant ECO2013-47092 (MINECO, Spain).

  • Sleep disorders
  • Telemedicine
  • Treatments
  • Copyright ©ERS 2015
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A bayesian cost-effectiveness analysis of a telemedicine-based strategy for the management of sleep apnea: A multicenter randomized controlled trial
Valentina Isetta, Miguel A. Negrín, Carmen Monasterio, Juan F. Masa, Nuria Feu, Ainhoa Álvarez, Francisco Campos-Rodriguez, Concepción Ruiz, Jorge Abad, Ramon Farré, Marina Galdeano, Patricia Lloberes, Cristina Embid, Mónica De la Peña, Javier Puertas, Mireia Dalmases, Josep M. Montserrat
European Respiratory Journal Sep 2015, 46 (suppl 59) PA3376; DOI: 10.1183/13993003.congress-2015.PA3376

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A bayesian cost-effectiveness analysis of a telemedicine-based strategy for the management of sleep apnea: A multicenter randomized controlled trial
Valentina Isetta, Miguel A. Negrín, Carmen Monasterio, Juan F. Masa, Nuria Feu, Ainhoa Álvarez, Francisco Campos-Rodriguez, Concepción Ruiz, Jorge Abad, Ramon Farré, Marina Galdeano, Patricia Lloberes, Cristina Embid, Mónica De la Peña, Javier Puertas, Mireia Dalmases, Josep M. Montserrat
European Respiratory Journal Sep 2015, 46 (suppl 59) PA3376; DOI: 10.1183/13993003.congress-2015.PA3376
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