Cost-effectiveness of positive airway pressure modalities in obesity hypoventilation syndrome with severe obstructive sleep apnoea

Masa, J.F. ; Mokhlesi, B. ; Benítez, I. ; Gómez De Terreros Caro, F.J. ; Sánchez-Quiroga, M.A. ; Romero, A. ; Caballero, C. ; Alonso-Álvarez, M.L. ; Ordax-Carbajo, E. ; Gómez-Garciá, T. ; González, M. ; López-Martín, S. ; Marin, J.M. (Universidad de Zaragoza) ; Martí, S. ; Diáz-Cambriles, T. ; Chiner, E. ; Egea, C. ; Barca, J. ; Vázquez-Polo, F.J. ; Negrín, M.A. ; Martel-Escobar, M. ; Barbé, F. ; Corral-Penãfiel, J.

Resumen: Background: Obesity hypoventilation syndrome (OHS) is treated with either non-invasive ventilation (NIV) or CPAP, but there are no long-term cost-effectiveness studies comparing the two treatment modalities.
Objectives: We performed a large, multicentre, randomised, open-label controlled study to determine the comparative long-term cost and effectiveness of NIV versus CPAP in patients with OHS with severe obstructive sleep apnoea (OSA) using hospitalisation days as the primary outcome measure.
Methods: Hospital resource utilisation and within trial costs were evaluated against the difference in effectiveness based on the primary outcome (hospitalisation days/year, transformed and non-transformed in monetary term). Costs and effectiveness were estimated from a log-normal distribution using a Bayesian approach. A secondary analysis by adherence subgroups was performed.
Results: In total, 363 patients were selected, 215 were randomised and 202 were available for the analysis. The median (IQR) follow-up was 3.01 (2.91-3.14) years for NIV group and 3.00 (2.92-3.17) years for CPAP. The mean (SD) Bayesian estimated hospital days was 2.13 (0.73) for CPAP and 1.89 (0.78) for NIV. The mean (SD) Bayesian estimated cost per patient/year in the NIV arm, excluding hospitalisation costs, was 2075.98 (91.6), which was higher than the cost in the CPAP arm of 1219.06 (52.3); mean difference 857.6 (105.5). CPAP was more cost-effective than NIV (99.5% probability) because longer hospital stay in the CPAP arm was compensated for by its lower costs. Similar findings were observed in the high and low adherence subgroups.
Conclusion: CPAP is more cost-effective than NIV; therefore, CPAP should be the preferred treatment for patients with OHS with severe OSA. Trial registration number: NCT01405976

Idioma: Inglés

DOI: 10.1136/thoraxjnl-2019-213622

Año: 2020

Publicado en: Thorax 75, 6 (2020), NCT01405976 [9 pp]
ISSN: 0040-6376

Factor impacto JCR: 9.139 (2020)

Categ. JCR: RESPIRATORY SYSTEM rank: 7 / 64 = 0.109 (2020) - Q1 - T1

Factor impacto SCIMAGO: 3.083 - Pulmonary and Respiratory Medicine (Q1)

Tipo y forma: Artículo (Versión definitiva)

Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)