Abstract
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 language | English |
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Article number | PII jc-19-00023 |
Pages (from-to) | 1477-1485 |
Number of pages | 9 |
Journal | Journal of clinical sleep medicine |
Volume | 15 |
Issue number | 10 |
Early online date | 5-Sept-2019 |
DOIs | |
Publication status | Published - 15-Oct-2019 |
Keywords
- costs and cost analysis
- randomized controlled trial
- sleep
- CARDIOVASCULAR-DISEASE
- ORAL APPLIANCE
- CONTROLLED-TRIAL
- ASSOCIATION
- HYPERTENSION
- CROSSOVER
- OUTCOMES
- STROKE
- RISK
- MEN