Cost-effectiveness of positive airway pressure modalities in obesity hypoventilation syndrome with severe obstructive sleep apnoea

Abstract

BackgroundObesity hypoventilation syndrome (OHS) is treated with either non-invasive ventilation (NIV) or CPAP, but there are no long-term cost-effectiveness studies comparing the two treatment modalities.ObjectivesWe performed a large, multicentre, randomised, open-label controlled study to determine the comparative long-term cost and effectiveness of NIV versus CPAP in patients with OHS with severe obstructive sleep apnoea (OSA) using hospitalisation days as the primary outcome measure.MethodsHospital resource utilisation and within trial costs were evaluated against the difference in effectiveness based on the primary outcome (hospitalisation days/year, transformed and non-transformed in monetary term). Costs and effectiveness were estimated from a log-normal distribution using a Bayesian approach. A secondary analysis by adherence subgroups was performed.ResultsIn total, 363 patients were selected, 215 were randomised and 202 were available for the analysis. The median (IQR) follow-up was 3.01 (2.91–3.14) years for NIV group and 3.00 (2.92–3.17) years for CPAP. The mean (SD) Bayesian estimated hospital days was 2.13 (0.73) for CPAP and 1.89 (0.78) for NIV. The mean (SD) Bayesian estimated cost per patient/year in the NIV arm, excluding hospitalisation costs, was €2075.98 (91.6), which was higher than the cost in the CPAP arm of €1219.06 (52.3); mean difference €857.6 (105.5). CPAP was more cost-effective than NIV (99.5% probability) because longer hospital stay in the CPAP arm was compensated for by its lower costs. Similar findings were observed in the high and low adherence subgroups.ConclusionCPAP is more cost-effective than NIV; therefore, CPAP should be the preferred treatment for patients with OHS with severe OSA.Trial registration numberNCT01405976

Long-Term Adherence to Positive Airway Pressure Therapy in Saudi Ambulatory Patients with Obesity Hypoventilation Syndrome and Severe Obstructive Sleep Apnea: A One-Year Follow-Up Prospective Observational Study

“…5,33,41,42 Additionally, CPAP is more cost-effective than BPAP and other modes of NIV. 43 Therefore, CPAP should be the initial treatment 31 On the other hand, in a longterm prospective observational study, Bouloukaki et al reported that patients using BPAP adhered better to therapy than patients using CPAP [40]. 35 However, this study included OHS patients with mild, moderate, and severe OSA.…”

Results of CPAP Titration and Short-Term Adherence Rates in Patients with Obesity Hypoventilation Syndrome and Mild/Moderate Obstructive Sleep Apnea

“…Additionally, CPAP is easily available in most parts of the world and is cheaper and easier to apply than BPAP and other modes of NIV. 50 Therefore, CPAP may be an adequate initial treatment for some stable ambulatory patients with OHS without severe OSA due to its relatively simple set-up, low cost, and efficacy. However, if sustained hypoxemia or alveolar hypoventilation continues in spite of eliminating obstructive events, patients should be shifted to BPAP therapy.…”

CPAP titration failure is not equivalent to long-term CPAP treatment failure in patients with obesity hypoventilation syndrome: a case series

“…4,6,8 Importantly, both CPAP and NIV were equally effective in reducing the need for daytime supplemental oxygen therapy in patients with OHS, 4 with CPAP being significantly less costly. 13 Based on the abbreviated alveolar air equation while breathing ambient room air, for every 1 mm Hg reduction in PaCO 2 , the PaO 2 should increase by 1.25 mm Hg. 21 In our case series, the improvement in awake PaCO 2 did not lead to the expected degree of improvement in awake PaO 2 .…”

“…4 Moreover, NIV is significantly costlier than CPAP. 13 It is not surprising that clinicians consider additional interventions when persistent hypoxemia is observed during CPAP titration. What remains unanswered is whether persistent hypoxemia during CPAP titration improves with time.…”