PMD9 CONTINUOUS POSITIVE AIRWAY PRESSURE DEVICE COMPARED TO USUAL CARE FOR SEVERE OBSTRUCTIVE SLEEP APNEA: A COST-EFFECTIVENESS ANALYSIS

Abstract

To estimate the incremental cost-effectiveness ratio (ICER) of incorporating continuous positive airway pressure device (CPAP) for the treatment of patients with severe obstructive sleep apnea (OSA), compared to the usual care in the Brazilian Private Healthcare System (PHS). A Markov model was constructed with the following health states: Event-free OSA, non-fatal stroke, non-fatal myocardial infarction (MI) and death, in addition to the events: traffic accident, MI and stroke. Eligible population consisted of patients with severe OSA (apnea-hypopnea index ≥ 30) in PHS. The analysis considered a lifetime horizon with a discount of 5% for costs and clinical outcomes. Direct medical costs for each health state/event were considered, as well as the cost of device acquisition/maintenance and medical follow-up of patients. Probabilistic sensitivity analyses were performed to explore parametric uncertainties. CPAP treatment is more expensive and more effective than the usual care, presenting 2.85 incremental life years and 3.21 incremental quality-adjusted life-years (QALY) and a cost of BRL 19,255. ICER was BRL 6,733/life years gained and BRL 5,995/QALY. That means the payer would disburse BRL 6,733 to promote one additional year of life and BRL 5,995 to promote an additional quality-adjusted life year for the patient using CPAP. Deterministic results are corroborated by the probabilistic analyses. OSA has a major impact on patients’ health, resulting in high costs for the health system. Although it is indicated for the treatment of patients with severe disease, treatment with CPAP is not available in the Brazilian PHS. This study shows that CPAP is a potential device to promote health benefits at low costs for payers. Although there is no cost-effectiveness threshold in Brazil, it is known that ICERs here presented are considered low for the analyzed outcomes.