Cost-effectiveness of positive airway pressure modalities in obesity hypoventilation syndrome with severe obstructive sleep apnoea
© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ..
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.
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E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:75 |
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| Enthalten in: |
Thorax - 75(2020), 6 vom: 21. Juni, Seite 459-467 |
| Sprache: |
Englisch |
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Journal Article |
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| Anmerkungen: |
Date Completed 17.08.2020 Date Revised 17.08.2020 published: Print-Electronic ClinicalTrials.gov: NCT01405976 Citation Status MEDLINE |
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| doi: |
10.1136/thoraxjnl-2019-213622 |
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| 245 | 1 | 0 | |a Cost-effectiveness of positive airway pressure modalities in obesity hypoventilation syndrome with severe obstructive sleep apnoea |
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| 500 | |a Date Revised 17.08.2020 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a ClinicalTrials.gov: NCT01405976 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ. | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a CONCLUSION: CPAP is more cost-effective than NIV; therefore, CPAP should be the preferred treatment for patients with OHS with severe OSA | ||
| 520 | |a TRIAL REGISTRATION NUMBER: NCT01405976 | ||
| 650 | 4 | |a Journal Article | |
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| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a non invasive ventilation | |
| 650 | 4 | |a sleep apnoea | |
| 700 | 1 | |a Mokhlesi, Babak |e verfasserin |4 aut | |
| 700 | 1 | |a Benítez, Iván |e verfasserin |4 aut | |
| 700 | 1 | |a Gómez de Terreros Caro, Francisco Javier |e verfasserin |4 aut | |
| 700 | 1 | |a Sánchez-Quiroga, M-Ángeles |e verfasserin |4 aut | |
| 700 | 1 | |a Romero, Auxiliadora |e verfasserin |4 aut | |
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| 700 | 1 | |a Caballero-Eraso Estrella Ordax, Candela |e investigator |4 oth | |
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| 700 | 1 | |a Utrabo, Isabel |e investigator |4 oth | |
| 700 | 1 | |a Gonzalez-Mangado, Nicolas |e investigator |4 oth | |
| 700 | 1 | |a F Troncoso, María |e investigator |4 oth | |
| 700 | 1 | |a Martinez-Martinez, M-Ángeles |e investigator |4 oth | |
| 700 | 1 | |a Castillejo, Elena Ojeda |e investigator |4 oth | |
| 700 | 1 | |a López-Padilla, Daniel |e investigator |4 oth | |
| 700 | 1 | |a Carrizo, Santiago |e investigator |4 oth | |
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