Costeffectiveness of Continuous Positive Airway P

Authors: Najib T Ayas J Mark FitzGerald John A Fleetham David P White Michael Schulzer C Frank Ryan Reza Ghaeli G William Mercer Peter Cooper Michael C Y Tan Carlo A Marra

Publish Date: 2006/05/08

Volume: 166, Issue: 9, Pages: 977-984

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Abstract

Markov model of patients not prescribed continuous positive airway pressure therapy MAIS indicates Modified Abbreviated Injury Scale MVC motor vehicle crash MAIS scores are described in the “Decision Model Structure” subsection of the “Methods” sectionMarkov model of patients prescribed continuous positive airway pressure CPAP therapy MAIS indicates Modified Abbreviated Injury Scale MVC motor vehicle crash MAIS scores are described in the “Decision Model Structure” subsection of the “Methods” sectionScatterplot displaying on the incremental costeffectiveness plane the incremental cost and effectiveness pairs resulting from 1000 iterations of the model comparing continuous positive airway pressure CPAP with no CPAP The slope of the line drawn from each point to the origin is the incremental costeffectiveness ratio of CPAP to no CPAP as estimated from 1 iteration of the model Points in the right upper quadrant represent iterations for which CPAP was more costly and more effective than no CPAP whereas points in the right lower quadrant represent simulations where CPAP was the dominant strategy ie more effective but less costly QALYs indicates qualityadjusted lifeyearsThe costeffectiveness acceptability curve plots the estimated probability that continuous positive airway pressure CPAP is costeffective vs societys willingness to pay for a qualityadjusted lifeyear QALY The probability of costeffectiveness is calculated as the proportion of Monte Carlo simulations indicating that either CPAP therapy leads to greater health outcomes at a price that is acceptable to society or in the present context only a theoretical possibility that no CPAP therapy leads to improved health outcomes but at a price that is too highBackground  Obstructive sleep apnea/hypopnea OSAH is a common disorder characterized by recurrent collapse of the upper airway during sleep and is associated with an increased risk of motor vehicle crashes MVCs Common firstline therapy for OSAH is continuous positive airway pressure CPAP We assessed the costeffectiveness of CPAP therapy vs none for the treatment of OSAHMethods  We used a 5year Markov model that considers the costs and qualityoflife improvements of CPAP therapy accounting for the gains from reduced MVC rates Utility values were obtained from published studies The MVC rates under the CPAP and noCPAP scenarios were calculated from National Highway Traffic Safety Administration data and a systematic review of published studies Costs of MVCs equipment and physicians were obtained from US Medicare and the National Highway Traffic Safety Administration The target population included male and female patients aged 25 to 54 years and newly diagnosed as having moderate to severe OSAH We examined the findings from the perspectives of a thirdparty payer and societyResults  From a thirdparty payer or a societal perspective CPAP therapy was more effective but more costly than no CPAP with incremental costeffectiveness ratios of 3354 or 314 per qualityadjusted lifeyear gained respectively The incremental costeffectiveness ratio estimate was most dependent on viewpoint varying more than 10fold between societal and thirdparty payer perspectives and choice of utility measurement method varying more than 5fold between the use of standard gamble and EuroQol 5D utility assessment values

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