Cost-effectiveness of Continuous Positive Airway Pressure Treatment in Moderate-Severe Obstructive Sleep Apnea Syndrome

The Impact of Treatments for OSA on Monetized Health Economic Outcomes

“…Study Design: The most common study design was a retrospective cohort study, which was employed in 10 studies. [21][22][23][24][25][26][27][28][29][30] Three studies employed RCT designs, [31][32][33] and one study employed a quasi-experimental design. 34 Other designs included two case-control studies 35,36 and a prospective cohort study.…”

“…Seven other cohort studies did not adjust for important covariates; thus, risk of bias was deemed unclear, and these studies were scored seven stars. 22,24,27,30,34,36,37 A final cohort study 28 did not clarify representativeness of the sample and was also scored seven stars.…”

“…25 Studies were published between the years of 1994 28 and 2016. 30 Study locations included the United Studies (n ¼ 4), [23][24][25]29 the United Kingdom (n ¼ 3), 31,33,35 Canada (n ¼ 4), 21,22,28,37 and one each from Denmark, 26 Finland, 34 France, 32 Israel, 36 Spain, 30 and Sweden. 27 Although one study each included all-male 21 and all-female 22 samples, most empirical studies were sex-mixed and included > 70% male participants.…”

“…In clinic-based studies, OSA was diagnosed during overnight polysomnography (PSG; n ¼ 9), 21,22,27,28,32,33,36,37,38 home sleep apnea testing (HSAT; n ¼ 1), 31 or mixed approaches such as HSAT followed by PSG if necessary (n ¼ 2). 30,34 In administrative review studies, OSA diagnosis was operationalized by diagnostic, procedural, or equipment-related codes indicative of OSA (n ¼ 6). [23][24][25][26]29,35 OSA Treatments: In the vast majority of studies, the OSA treatment was PAP, including CPAP, autoadjusting PAP, and bilevel PAP.…”

“…[23][24][25][26]29,35 OSA Treatments: In the vast majority of studies, the OSA treatment was PAP, including CPAP, autoadjusting PAP, and bilevel PAP. PAP adherence was reported in all but five studies, [23][24][25]28,39 with a roughly equal number of studies employing objective (eg, machine counter or Secure Digital download) [30][31][32][33][34] and subjective (eg, patient or bed-partner report) 21,22,27,35,37 measures of adherence. Other treatment modalities included surgical approaches (n ¼ 3) 26,29,36 and OAs (n ¼ 1).…”