Citation

Wickwire EM, Albrecht JS, Towe M, Abariga SA, Diaz-Abad M, Shipper AG, Cooper L, Assefa S, Tom SE, Scharf SM. Chest 2019; 155(5): 947-961.

Affiliation

Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD.

Copyright

(Copyright © 2019, American College of Chest Physicians)

DOI

10.1016/j.chest.2019.01.009

PMID

30664857

Abstract

STUDY OBJECTIVES: To review systematically the published literature regarding the impact of treatment for obstructive sleep apnea (OSA) on monetized health economic outcomes.

METHODS: Customized structured searches were performed in PubMed, Embase (Embase.com), and the Cochrane Central Register of Controlled Trials (Wiley) databases. Reference lists of eligible studies were also analyzed. Titles and abstracts were examined, and articles were identified for full-text review. Studies that met inclusion criteria were evaluated in detail, and study characteristics were extracted using a standardized template. Quantitative characteristics of the studies were summarized, and a qualitative synthesis was performed.

RESULTS: Literature searches identified 2,017 non-redundant abstracts, and 196 full-text articles were selected for review. Seventeen studies met inclusion criteria and were included in the final synthesis. Seven studies included formal cost-effectiveness or cost-utility analyses. Ten studies employed cohort designs, and four studies employed randomized controlled trial or quasi-experimental designs. Positive airway pressure was the most common treatment modality, but oral appliances and surgical approaches were also included. The most common health economic outcomes were health care utilization and quality-adjusted life years (QALYs). Follow-up periods ranged from 6 weeks to 5 years. Overall, 15 of 18 comparisons found that treatment of OSA resulted in a positive economic impact. Treatment adherence and OSA severity were positively associated with cost-effectiveness.

CONCLUSIONS: Although study methodologies varied widely, evidence consistently suggests that treatment of obstructive apnea is associated with favorable economic outcomes, including QALYs within accepted ranges of cost-effectiveness, reduced health care utilization, increased workplace productivity, and diminished accident risk.

Copyright © 2019. Published by Elsevier Inc.

Language: en

Keywords

accident risk; health care utilization; health economics; sleep apnea; treatment; workplace productivity