Abstract
Study Objectives: Limited evidence exists on the cost-effectiveness of mandibular advancement device (MAD) compared to continuous positive airway pressure (CPAP) therapy in moderate obstructive sleep apnea (OSA). Therefore, this study compares the clinical and cost-effectiveness of MAD therapy with CPAP therapy in moderate OSA.
Methods: In a multicentre randomized controlled trial, patients with an apnea-hypopnea index (AHI) of 15 to 30 events/h were randomized to either MAD or CPAP. Incremental cost-effectiveness and cost-utility ratios (ICER/ICUR, in terms of AHI reduction and quality-adjusted life-years [QALYs, based on the EuroQol Five-Dimension Quality of Life questionnaire]) were calculated after 12 months, all from a societal perspective.
Results: In the 85 randomized patients (n = 42 CPAP, n = 43 MAD), AHI reduction was significantly greater with CPAP (median reduction AHI 18.3 [14.8–22.6] events/h) than with MAD therapy (median reduction AHI 13.5 [8.5–18.4] events/h) after 12 months. Societal costs after 12 months were higher for MAD than for CPAP (mean difference V2.156). MAD was less cost-effective than CPAP after 12 months (ICER −V305 [−V3.003 to V1.572] per AHI point improvement). However, in terms of QALY, MAD performed better than CPAP after 12 months (V33.701 [−V191.106 to V562.271] per QALY gained). Conclusions: CPAP was more clinically effective (in terms of AHI reduction) and cost-effective than MAD. However, costs per QALY was better with MAD as compared to CPAP. Therefore, CPAP is the first-choice treatment option in moderate OSA and MAD may be a good alternative. Clinical Trial Registration: Registry: ClinicalTrials.gov; Identifier: NCT01588275.
Methods: In a multicentre randomized controlled trial, patients with an apnea-hypopnea index (AHI) of 15 to 30 events/h were randomized to either MAD or CPAP. Incremental cost-effectiveness and cost-utility ratios (ICER/ICUR, in terms of AHI reduction and quality-adjusted life-years [QALYs, based on the EuroQol Five-Dimension Quality of Life questionnaire]) were calculated after 12 months, all from a societal perspective.
Results: In the 85 randomized patients (n = 42 CPAP, n = 43 MAD), AHI reduction was significantly greater with CPAP (median reduction AHI 18.3 [14.8–22.6] events/h) than with MAD therapy (median reduction AHI 13.5 [8.5–18.4] events/h) after 12 months. Societal costs after 12 months were higher for MAD than for CPAP (mean difference V2.156). MAD was less cost-effective than CPAP after 12 months (ICER −V305 [−V3.003 to V1.572] per AHI point improvement). However, in terms of QALY, MAD performed better than CPAP after 12 months (V33.701 [−V191.106 to V562.271] per QALY gained). Conclusions: CPAP was more clinically effective (in terms of AHI reduction) and cost-effective than MAD. However, costs per QALY was better with MAD as compared to CPAP. Therefore, CPAP is the first-choice treatment option in moderate OSA and MAD may be a good alternative. Clinical Trial Registration: Registry: ClinicalTrials.gov; Identifier: NCT01588275.
| Original language | English |
|---|---|
| Pages (from-to) | 1477-1485 |
| Journal | Journal of Clinical Sleep Medicine |
| Volume | 15 |
| Issue number | 10 |
| DOIs | |
| Publication status | Published - 15 Oct 2019 |
Funding
All authors have seen and approved the manuscript. This study was funded by SomnoMed Goedegebuure and VitalAire Nederland BV. GEV, AH, and PJW report grants from SomnoMed Goedegebuure and from VitalAire Nederland BV, during the conduct of the study. AH reports personal fees for being Medical advisor from Somnomed, Airway Management, and Zephyr Sleep Technologies, outside the submitted work. PJW reports grants and personal fees from Philips, grants and personal fees from RESMED, grants from VIVISOL, personal fees from Synapse, and from Bresotec, outside the submitted work. The other authors report no conflicts of interest.
| Funders | Funder number |
|---|---|
| SomnoMed Goedegebuure | |
| VitalAire Nederland BV |
