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 ex-amined the findings from the perspectives of a thirdparty 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.

This study examines the role of family and friends in accounting for alcohol, tobacco, and marijuana use among young adolescents. The sample included 1,008 males and 1,040 females with a mean age of 14.5 years. Lack of parental affection, concern, involvement, and modeling appeared to be centralfactors in the family's influence, which accounted for up to 22% of the variance in drug use. Friends' delinquency and use of drugs largely determined the influence of friendship, which accounted for up to 40% of adolescent drug use. Comparisons are made between characteristics of family and friends. Family and friends have differing influences upon young people, and these in turn depend on chronological or biological age, culture, historical time, sex, personal characteristics, and the behavior in question. Influence as causation is difficult to demonstrate unequivocally; however, what can be shown is the extent of covariation between family or friendship characteristics and the behavior of interest. Such descriptive information is one source from which causative theories may be developed. This study concerns the extent to which drug use by young adolescents is related to characteristics of both their family and their friends. The importance of both family and friends in the prediction of drug use has been recognized for some time. However, research in this area has

Wessel van den Berg and colleagues outline how increasing male partner involvement in efforts to reduce mother-to-child HIV transmission in South Africa may improve maternal and infant outcomes.

No abstract