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Najib T. Ayas, MD, MPH; J. Mark FitzGerald, MD; John A. Fleetham, MD; David P. White, MD; Michael Schulzer, MD, PhD; C. Frank Ryan, MD; Reza Ghaeli, PhD; G. William Mercer, PhD; Peter Cooper, BASc; Michael C. Y. Tan, MA, MSc; Carlo A. Marra, PharmD, PhD

Arch Intern Med. 2006;166:977-984.

Background  Obstructive sleep apnea/hypopnea (OSAH) is a common disorder characterized by recurrent collapse of the upper airway during sleep, and is associated with an increased risk of motor vehicle crashes (MVCs). Common first-line therapy for OSAH is continuous positive airway pressure (CPAP). We assessed the cost-effectiveness of CPAP therapy vs none for the treatment of OSAH.

Methods  We used a 5-year Markov model that considers the costs and quality-of-life improvements of CPAP therapy, accounting for the gains from reduced MVC rates. Utility values were obtained from published studies. The MVC rates under the CPAP and no-CPAP scenarios were calculated from National Highway Traffic Safety Administration data and a systematic review of published studies. Costs of MVCs, equipment, and physicians were obtained from US Medicare and the National Highway Traffic Safety Administration. The target population included male and female patients aged 25 to 54 years and newly diagnosed as having moderate to severe OSAH. We examined the findings from the perspectives of a third-party payer and society.

Results  From a third-party payer or a societal perspective, CPAP therapy was more effective but more costly than no CPAP, with incremental cost-effectiveness ratios of $3354 or $314 per quality-adjusted life-year gained, respectively. The incremental cost-effectiveness ratio estimate was most dependent on viewpoint (varying more than 10-fold between societal and third-party payer perspectives) and choice of utility measurement method (varying more than 5-fold between the use of standard gamble and EuroQol 5D utility assessment values).

Conclusion  When quality of life, costs of therapy, and MVC outcomes are considered, CPAP therapy for patients with OSAH is economically attractive.

Author Affiliations: Department of Medicine and Division of Respiratory Medicine (Drs Ayas, FitzGerald, Fleetham, and Ryan), Applied Research and Evaluation Services (Dr Mercer), and Faculty of Pharmaceutical Sciences (Dr Marra), University of British Columbia, Vancouver; Sleep Disorders Program, Vancouver Acute Hospitals, Vancouver (Drs Ayas, Fleetham, and Ryan); Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver (Drs Ayas, FitzGerald, Schulzer, and Marra and Mr Tan); Insurance Corporation of British Columbia, Vancouver (Dr Ghaeli and Mr Cooper); and Division of Sleep Medicine, Brigham and Women's Hospital, Boston, Mass (Dr White).

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