The Impact of Treatments for OSA on Monetized Health Economic Outcomes

Abstract

To review systematically the published literature regarding the impact of treatment for OSA on monetized health economic outcomes. METHODS: Customized structured searches were performed in PubMed, Embase (Embase. com), and the Cochrane Central Register of Controlled Trials (Wiley) databases. Reference lists of eligible studies were also analyzed. Titles and abstracts were examined, and articles were identified for full-text review. Studies that met inclusion criteria were evaluated in detail, and study characteristics were extracted using a standardized template. Quantitative characteristics of the studies were summarized, and a qualitative synthesis was performed. RESULTS: Literature searches identified 2,017 nonredundant abstracts, and 196 full-text articles were selected for review. Seventeen studies met inclusion criteria and were included in the final synthesis. Seven studies included formal cost-effectiveness or cost-utility analyses. Ten studies employed cohort designs, and four studies employed randomized controlled trial or quasi-experimental designs. Positive airway pressure was the most common treatment modality, but oral appliances and surgical approaches were also included. The most common health economic outcomes were health-care use (HCU) and quality-adjusted life years (QALYs). Follow-ups ranged from 6 weeks to 5 years. Overall, 15 of 18 comparisons found that treatment of OSA resulted in a positive economic impact. Treatment adherence and OSA severity were positively associated with cost-effectiveness. CONCLUSIONS: Although study methodologies varied widely, evidence consistently suggested that treatment of OSA was associated with favorable economic outcomes, including QALYs, within accepted ranges of cost-effectiveness, reduced HCU, and reduced monetized costs.

Global Risk Factor Evaluation of Obstructive Sleep Apnea in Relation to Research Activity and Socioeconomic Factors

“…This is in line with recent studies showing that OSA still remains underdiagnosed/untreated even in highly industrialized nations due to a mismatch between the growing demand and actual capacity, causing long wait times [ 58 , 59 , 60 , 61 ]. Consequently, since costs linked to undiagnosed OSA outweigh by far the costs of treating OSA, this discrepancy further increases the economic burden for healthcare systems worldwide [ 19 , 62 ]. Overall, in light of the increasing recognition of the heterogeneity of OSA depending on age, sex, race/ethnicity, as well as socioeconomic factors [ 18 , 57 ], and given the fact that the majority of epidemiologic studies on OSA focus around middle-aged white men from industrial nations, future studies depicting the actual epidemiologic aspects and identifying the individual needs in terms of diagnosis and treatment of the respective phenotype are needed.…”

“…Given the socioeconomic strain of undiagnosed/untreated OSA [19], there is a tremendous need to find cost-effective treatment alternatives and to further enhance novel and personalized approaches reflecting the true burden and satisfying the individual needs of the heterogeneous world population. Thus, to uncover the countries and areas most affected by a mismatch between research activity and estimated burden, we here present an in-depth analysis of the global OSA research in relation to a global risk factor analysis of OSA and socioeconomic characters of the publishing countries.…”

Health Preference Measures in Patients with Obstructive Sleep Apnea Syndrome Undergoing Continuous Positive Airway Pressure Therapy: Data from a Randomized Trial

“…Given the high prevalence of OSAS and its major impact on quality of life, morbidity, and mortality, evaluation of treatments in terms of patient-preference and cost-effectiveness are es-sential. However, the performance of different utility instruments in the evaluation of treatment effectiveness in patients with OSAS over time has not been extensively evaluated [24]. Therefore, the current study compares the performance of various utility instruments in reflecting treatment effects in patients with OSAS participating in a randomized trial of CPAP using 2 pressure setting modes, that is, autoadjusted (autoCPAP) and fixed mask pressure (fCPAP) over the course of 2 years [25].…”

A Tailored Motivational Messages Library for a Mobile Health Sleep Behavior Change Support System to Promote Continuous Positive Airway Pressure Use Among Patients With Obstructive Sleep Apnea: Development, Content Validation, and Testing

“…Thus, OSA accounts for a significant portion of health care costs, either directly or by means of its associated illnesses and diseases [ 4 ]. In the United States alone, the estimated total societal-level cost attributed to OSA is reported to be US $160 billion annually [ 5 ].…”

“…Continuous positive airway pressure (CPAP) therapy is the most effective treatment for OSA [ 6 , 7 ]. CPAP therapy has been found to improve cognitive processing and daily functioning; reduce daytime sleepiness [ 8 ]; and reduce health care costs, physician visits, and work absences [ 5 ]. Despite the reported benefits of CPAP therapy in treating OSA, its effectiveness is reduced by less-than-optimal adherence/usage.…”