Clinical- and Cost-Effectiveness of a Mandibular Advancement Device Versus Continuous Positive Airway Pressure in Moderate Obstructive Sleep Apnea

Grietje E. de Vries*, Aarnoud Hoekema, Karin M. Vermeulen, Johannes Q. P. J. Claessen, Wouter Jacobs, Jan van der Maten, Johannes H. van der Hoeven, Boudewijn Stegenga, Huib A. M. Kerstjens, Peter J. Wijkstra

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

12 Citations (Scopus)


Study Objectives: Limited evidence exists on the cost-effectiveness of mandibular advancement device (MAD) compared to continuous positive airway pressure (CPAP) therapy in moderate obstructive sleep apnea (OSA). Therefore, this study compares the clinical and cost-effectiveness of MAD therapy with CPAP therapy in moderate OSA.

Methods: In a multicentre randomized controlled trial, patients with an apnea-hypopnea index (AHI) of 15 to 30 events/h were randomized to either MAD or CPAP. Incremental cost-effectiveness and cost-utility ratios (ICER/ICUR, in terms of AHI reduction and quality-adjusted life-years [QALYs, based on the EuroQol Five-Dimension Quality of Life questionnaire]) were calculated after 12 months, all from a societal perspective.

Results: In the 85 randomized patients (n = 42 CPAP, n = 43 MAD), AHI reduction was significantly greater with CPAP (median reduction AHI 18.3 [14.8-22.6] events/h) than with MAD therapy (median reduction AHI 13.5 [8.5-18.4] events/h) after 12 months. Societal costs after 12 months were higher for MAD than for CPAP (mean difference (sic)2.156). MAD was less cost-effective than CPAP after 12 months (ICER -(sic)305 [-(sic)3.003 to (sic)1.572] per AHI point improvement). However, in terms of QALY, MAD performed better than CPAP after 12 months ((sic)33.701 [-(sic)191.106 to (sic)562.271] per QALY gained).

Conclusions: CPAP was more clinically effective (in terms of AHI reduction) and cost-effective than MAD. However, costs per QALY was better with MAD as compared to CPAP. Therefore, CPAP is the first-choice treatment option in moderate OSA and MAD may be a good alternative.

Original languageEnglish
Article numberPII jc-19-00023
Pages (from-to)1477-1485
Number of pages9
JournalJournal of clinical sleep medicine
Issue number10
Early online date5-Sep-2019
Publication statusPublished - 15-Oct-2019


  • costs and cost analysis
  • randomized controlled trial
  • sleep
  • RISK
  • MEN

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