A cost-effectiveness analysis of nasal surgery to increase continuous positive airway pressure adherence in sleep apnea patients with nasal obstruction

Abstract

Objectives/Hypothesis Nasal surgery has been implicated to improve continuous positive airway pressure (CPAP) compliance in patients with obstructive sleep apnea (OSA) and nasal obstruction. However, the cost-effectiveness of nasal surgery to improve CPAP compliance is not known. We modeled the cost-effectiveness of two types of nasal surgery versus no surgery in patients with OSA and nasal obstruction undergoing CPAP therapy. Study Design Cost-effectiveness decision tree model. Methods We built a decision tree model to identify conditions under which nasal surgery would be cost-effective to improve CPAP adherence over the standard of care. We compared turbinate reduction and septoplasty to nonsurgical treatment over varied time horizons from a third-party payer perspective. We included variables for cost of untreated OSA, surgical cost and complications, improved compliance postoperatively, and quality of life. Results Our study identified nasal surgery as a cost-effective strategy to improve compliance of OSA patients using CPAP across a range of plausible model assumptions regarding the cost of untreated OSA, the probability of adherence improvement, and a chronic time horizon. The relatively lower surgical cost of turbinate reduction made it more cost-effective at earlier time horizons, whereas septoplasty became cost-effective after a longer timespan. Conclusions Across a range of plausible values in a clinically relevant decision model, nasal surgery is a cost-effective strategy to improve CPAP compliance in OSA patients with nasal obstruction. Our results suggest that OSA patients with nasal obstruction who struggle with CPAP therapy compliance should undergo evaluation for nasal surgery.

The Importance of Mask Selection on Continuous Positive Airway Pressure Outcomes for Obstructive Sleep Apnea. An Official American Thoracic Society Workshop Report

“…A cost-effectiveness analysis of nasal surgery to increase CPAP adherence in patients with OSA and nasal obstruction pointed out that nasal surgery is cost-effective in almost every patient with OSA and nasal obstruction, that turbinate reduction can be cost-positive in the short term, and that septoplasty can have a higher cost/benefit outcome after a longer time span ( 22 ).…”

Surgery for Sleep-Disordered Breathing

“…Nasal surgery improved the OSAS severity as measured by PSG, subjective complaints, and three-dimensional reconstructed computed tomography scans [15]. This operation is a cost-effective strategy for improving CPAP compliance in OSAS patients with nasal obstruction [16], although the optimum operative techniques have not been studied. Nasal dilators have shown efficacy in improving nasal breathing but not in improving obstructive sleep apnea outcomes [17], suggesting a need for nasal surgery.…”

Anatomical Phenotypes of Upper Airway in OSA Subjects and its Influence on PAP Adherence

“…술이나 약물 치료 협착된 상기도의 해부학적 구조를 개 선시킴으로써 PAP therapy 순응도를 향상시킬 수 있다 고 보고된 바 있다 13,14). PAP의 순응도 차이에 따라 OSA 환자에서 다양한 수면 검사의 척도와 비중격의 편위, 하 비갑개 비대, 편도의 크기 및 구개 위치 등을 상기도의 해부학적 구조 차이 및 phenotype을 분석하고 이에 맞 춰서 적절한 치료 방법을 환자에게 제공하는 연구가 보 다 효율적인 OSA치료 및 그 성공율을 높이는 데 있어서 임상적으로 필요할 것으로 생각된다.…”