Long-Term Cost-Effectiveness of Upper Airway Stimulation for the Treatment of Obstructive Sleep Apnea: A Model-Based Projection Based on the STAR Trial
| Autor: | Eric J. Kezirian, Jan B. Pietzsch, Shan Liu, Abigail M. Garner, Patrick J. Strollo |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Male Risk medicine.medical_specialty Cost effectiveness Cost-Benefit Analysis medicine.medical_treatment Myocardial Infarction Physiology (medical) Humans Medicine Continuous positive airway pressure Stroke health care economics and organizations Aged Sleep Apnea Obstructive business.industry Apnea Middle Aged medicine.disease Markov Chains Quality-adjusted life year Long-Term Cost-Effectiveness of Upper Airway Stimulation for OSA Obstructive sleep apnea Editorial Relative risk Cohort Emergency medicine Physical therapy Female Quality-Adjusted Life Years Neurology (clinical) medicine.symptom business |
| Zdroj: | Sleep. 38:735-744 |
| ISSN: | 1550-9109 0161-8105 |
| DOI: | 10.5665/sleep.4666 |
| Popis: | Study objectives Upper airway stimulation (UAS) is a new approach to treat moderate-to-severe obstructive sleep apnea. Recently, 12-month data from the Stimulation Treatment for Apnea Reduction (STAR) trial were reported, evaluating the effectiveness of UAS in patients intolerant or non-adherent to continuous positive airway pressure therapy. Our objective was to assess the cost-effectiveness of UAS from a U.S. payer perspective. Design A 5-state Markov model was used to predict cardiovascular endpoints (myocardial infarction [MI], stroke, hypertension), motor vehicle collisions (MVC), mortality, quality-adjusted life years (QALYs), and costs. We computed 10-year relative event risks and the lifetime incremental cost-effectiveness ratio (ICER) in $/QALY, comparing UAS therapy to no treatment under the assumption that the STAR trial-observed reduction in mean apnea-hypopnea index from 32.0 to 15.3 events/h was maintained. Costs and effects were discounted at 3% per year. Setting U.S. healthcare system; third-party payer perspective. Participants 83% male cohort with mean age of 54.5 years. Interventions UAS vs. no treatment. Measurements and results UAS substantially reduced event probabilities over 10 years (relative risks: MI 0.63; stroke 0.75; MVC 0.34), and was projected to add 1.09 QALYs over the patient's lifetime. Costs were estimated to increase by $42,953, resulting in a lifetime ICER of $39,471/QALY. Conclusions Relative to the acknowledged willingness-to-pay threshold of $50,000-$100,000/QALY, our results indicate upper airway stimulation is a cost-effective therapy in the U.S. healthcare system. |
| Databáze: | OpenAIRE |
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