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Long-term positive airway pressure therapy in obesity hypoventilation syndrome. Cost study

Mª Ángeles Sanchez Quiroga, Juan Fernando Masa Jiménez, Babak Mokhlesi, Ivan Benitez, Francisco Javier Gómez De Terreros, Auxiliadora Romero, Candela Caballero Eraso, Joaquin Teran Santos, María Luz Alonso Álvarez, Maria Fernanda Troncoso, Monica González, Soledad López Martin, José María Marín, Sergi Marti, Trinidad Díaz Cambriles, Eusebi Chiner, Carlos Egea Santaolalla, Javier Barca, Francisco José Vázquez Polo, Miguel Angel Negrin, Maria Martel Escobar, Ferran Barbe, Jaime Corral
European Respiratory Journal 2019 54: PA2013; DOI: 10.1183/13993003.congress-2019.PA2013
Mª Ángeles Sanchez Quiroga
1Virgen del Puerto Hospital, Plasencia, Spain
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  • For correspondence: mariansanqui@gmail.com
Juan Fernando Masa Jiménez
2San Pedro Alcántara Hospital, Cáceres, Spain
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Babak Mokhlesi
3University of Chicago, Chicago, United States of America
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Ivan Benitez
4Arnau de Vilanova Hospital, Lérida, Spain
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Francisco Javier Gómez De Terreros
2San Pedro Alcántara Hospital, Cáceres, Spain
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Auxiliadora Romero
5Virgen del Rocío Hospital, Sevilla, Spain
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Candela Caballero Eraso
5Virgen del Rocío Hospital, Sevilla, Spain
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Joaquin Teran Santos
6University Hospital, Burgos, Spain
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María Luz Alonso Álvarez
6University Hospital, Burgos, Spain
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Maria Fernanda Troncoso
7Fundación Jiménez Díaz Hospital, Madrid, Spain
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Monica González
8Valdecilla Hospital, Santander, Spain
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Soledad López Martin
9Gregorio Marañón Hospital, Madrid, Spain
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José María Marín
10Miguel Servet University Hospital, Zaragoza, Spain
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Sergi Marti
11Valle de Hebron Hospital, Barcelona, Spain
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Trinidad Díaz Cambriles
1212 de Octubre Hospital, Madrid, Spain
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Eusebi Chiner
13San Juan Hospital, Alicante, Spain
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Carlos Egea Santaolalla
14Alava University Hospital, Vitoria, Spain
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Javier Barca
15Extremadura University, Vitoria, Spain
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Francisco José Vázquez Polo
16Las Palmas de Gran Canarias University, Canary Islands, Spain
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Miguel Angel Negrin
16Las Palmas de Gran Canarias University, Canary Islands, Spain
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Maria Martel Escobar
16Las Palmas de Gran Canarias University, Canary Islands, Spain
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Ferran Barbe
4Arnau de Vilanova Hospital, Lérida, Spain
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Jaime Corral
2San Pedro Alcántara Hospital, Cáceres, Spain
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Abstract

Rationale: Obesity hypoventilation syndrome (OHS) is commonly treated with noninvasive ventilation (NIV) or CPAP. NIV is more complex and costly but provides ventilatory support. To date there have been no long-term or cost trials comparing these treatment modalities.

Methods: We performed a large, randomized, multicenter, open-label controlled trial in Spain to compare the long-term effectiveness of NIV and CPAP using hospitalization days/year-patient as the primary end point. We carried out a simple cost analysis including effectiveness cost during 3 year of follow-up. We included the following cost groups: visits, adjustment of NIV, tests, medication, therapies and hospital resources utilization. A sensitivity analysis was conducted according to 3 different scenarios guided by the International Gross Domestic Product.

Results: In total, 215 patients with untreated OHS and severe obstructive sleep apnea (OSA) were randomized to NIV or CPAP therapy and followed at least 3 years. The effectiveness was close between arms (mean difference NIV-CPAP: -0.19, 95% CI -1.13 to 0.75). The cost per patient/year was lower in the CPAP arm (1,898.2€; SD 1939.5) than the cost in the NIV arm (2,809.3€; SD 2901.6), mean difference -911.1€ (p <0.0001). The sensitivity analysis showed a minimum mean savings per patient/year with CPAP of -553.4€ (p <0.0001) and a maximum of -1,619.5€ (p<0.0001).

Conclusions: In stable patients with OHS and severe OSA, despite NIV having a slight advantage in effectiveness, CPAP could be considered the first line of treatment due to its lower cost but, a case-by-case assessment is recommended to detect patients who would benefit from a switch to NIV.

  • Apnoea / Hypopnea
  • Treatments
  • RCT (Randomized Controlled Trial)

Footnotes

Cite this article as: European Respiratory Journal 2019; 54: Suppl. 63, PA2013.

This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).

  • Copyright ©the authors 2019
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Long-term positive airway pressure therapy in obesity hypoventilation syndrome. Cost study
Mª Ángeles Sanchez Quiroga, Juan Fernando Masa Jiménez, Babak Mokhlesi, Ivan Benitez, Francisco Javier Gómez De Terreros, Auxiliadora Romero, Candela Caballero Eraso, Joaquin Teran Santos, María Luz Alonso Álvarez, Maria Fernanda Troncoso, Monica González, Soledad López Martin, José María Marín, Sergi Marti, Trinidad Díaz Cambriles, Eusebi Chiner, Carlos Egea Santaolalla, Javier Barca, Francisco José Vázquez Polo, Miguel Angel Negrin, Maria Martel Escobar, Ferran Barbe, Jaime Corral
European Respiratory Journal Sep 2019, 54 (suppl 63) PA2013; DOI: 10.1183/13993003.congress-2019.PA2013

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Long-term positive airway pressure therapy in obesity hypoventilation syndrome. Cost study
Mª Ángeles Sanchez Quiroga, Juan Fernando Masa Jiménez, Babak Mokhlesi, Ivan Benitez, Francisco Javier Gómez De Terreros, Auxiliadora Romero, Candela Caballero Eraso, Joaquin Teran Santos, María Luz Alonso Álvarez, Maria Fernanda Troncoso, Monica González, Soledad López Martin, José María Marín, Sergi Marti, Trinidad Díaz Cambriles, Eusebi Chiner, Carlos Egea Santaolalla, Javier Barca, Francisco José Vázquez Polo, Miguel Angel Negrin, Maria Martel Escobar, Ferran Barbe, Jaime Corral
European Respiratory Journal Sep 2019, 54 (suppl 63) PA2013; DOI: 10.1183/13993003.congress-2019.PA2013
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