A Bayesian cost-effectiveness analysis of a telemedicine-based strategy for the management of sleep apnoea: a multicentre randomised controlled trial

Abstract

Background Compliance with continuous positive airway pressure (CPAP) therapy is essential in patients with obstructive sleep apnoea (OSA), but adequate control is not always possible. This is clinically important because CPAP can reverse the morbidity and mortality associated with OSA. Telemedicine, with support provided via a web platform and video conferences, could represent a cost-effective alternative to standard care management. Aim To assess the telemedicine impact on treatment compliance, cost-effectiveness and improvement in quality of life (QoL) when compared with traditional face-to-face follow-up. Methods A randomised controlled trial was performed to compare a telemedicine-based CPAP follow-up strategy with standard face-to-face management. Consecutive OSA patients requiring CPAP treatment, with sufficient internet skills and who agreed to participate, were enrolled. They were followed-up at 1, 3 and 6 months and answered surveys about sleep, CPAP side effects and lifestyle. We compared CPAP compliance, costeffectiveness and QoL between the beginning and the end of the study. A Bayesian cost-effectiveness analysis with non-informative priors was performed. Results We randomised 139 patients. At 6 months, we found similar levels of CPAP compliance, and improved daytime sleepiness, QoL, side effects and degree of satisfaction in both groups. Despite requiring more visits, the telemedicine group was more cost-effective: costs were lower and differences in effectiveness were not relevant. Conclusions A telemedicine-based strategy for the follow-up of CPAP treatment in patients with OSA was as effective as standard hospital-based care in terms of CPAP compliance and symptom improvement, with comparable side effects and satisfaction rates. The telemedicine-based strategy had lower total costs due to savings on transport and less lost productivity (indirect costs). Trial register number NCT01716676.

Telemedicine-based proactive patient management during positive airway pressure therapy

“…The ability to utilise telemedicine to provide patient-focussed, proactive and intensive management of patients using PAP therapy facilitates the management of large patient populations, as well as significantly improving therapy continuation rates and usage. Telemedicine also appears to be a cost effective strategy for managing CPAP treatment in patients with OSA [16]. …”

“…It also offers the opportunity to provide quality care without dramatically escalating healthcare costs [16]. It is especially suited to the management of chronic diseases that require long-term monitoring to ensure successful therapy [17].…”

“Diagnosis of sleep apnea in network” respiratory polygraphy as a decentralization strategy

“…A European group has reported similar results after conducting a multicenter study that demonstrated the cost-effectiveness of telemonitoring CPAP treatment in patients with OSA. [18].…”

Tele-monitoring of ventilator-dependent patients: a European Respiratory Society Statement

“…CPAP and NIV may benefit these patients . With the aim of improving compliance as well as finding new diagnostic strategies, some studies investigated the role of tele-monitoring in the management sleep disorders [81][82][83][84][85][86].…”