Health utilities in evaluating intervention in the sleep apnoea/hypopnoea syndrome.
Formulating a rational health policy necessitates the ability to compare between different healthcare interventions and disease scenarios. Continuous positive airway pressure (CPAP) therapy with a conservative lifestyle strategy in sleep apnoea/hypopnoea syndrome (SAHS) was evaluated using health utility and quality-adjusted life years (QALYs) as outcome measures. A total 71 SAHS (apnoea/hypopnoea index > or = 15 h(-1)) patients completed a randomised, parallel group study over 3 months using utilities derived by the standard gamble approach (Usg) and European quality of life questionnaire (Euroqol) (Ueq). The severely impaired health status at baseline improved by 23% (Usg 0.32 to 0.55) adding 8 QALYs in the CPAP group, compared to a 4% improvement with 4.7 QALYs added in the lifestyle group (Usg 0.31 to 0.35). The Ueq showed a marginal change with CPAP (0.73 to 0.77) but did not demonstrate any improvement with lifestyle intervention. The health status impairment in sleep apnoea/hypopnoea syndrome patients is markedly improved by continuous positive airway pressure compared to a modest improvement with conservative lifestyle strategies using the standard gamble utility, which may be incorporated in effectiveness and economic analyses. The European quality of life questionnaire did not reflect a similar degree of impact and is probably not useful in this population.
Chakravorty
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Dept of Thoracic Medicine, Watford General Hospital, Watford, UK. indranil@altavista.net
Cayton
R M
RM
Szczepura
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A
D015438:Health Behavior; D006304:Health Status; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D010353:Patient Education as Topic; D017286:Polysomnography; D011175:Positive-Pressure Respiration; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012648:Self Care; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000628:therapy*; D011795:Surveys and Questionnaires