Cost-effectiveness of oral appliances in the treatment of obstructive sleep apnoea-hypopnoea.
OBJECTIVE
Oral appliances (OA) are commonly prescribed for the treatment of obstructive sleep apnoea-hypopnoea (OSAH), but there is limited evidence on their cost-effectiveness.


METHODS
A model was designed to simulate the costs and benefits of treatment of OSAH with OA or continuous positive airway pressure (CPAP) based on their effects on quality of life, motor vehicle crashes, and cardiovascular effects. The primary outcome was the incremental cost-effectiveness ratio (ICER) in terms of costs per one quality-adjusted life year (QALY) gained 5 years after treatment.


RESULTS
Compared with no treatment, OA results in $268 higher costs and an incremental QALY of 0.0899 per patient (ICER = $2,984/QALY). Compared with OA, CPAP resulted in $1,917 more costs and 0.0696 additional QALYs (ICER = $27,540/QALY). For the most part in the sensitivity analyses, CPAP remained cost-effective compared to OA, and OA remained cost-effective with respect to no treatment in almost all scenarios.


CONCLUSIONS
OAs are less economically attractive than CPAP but remain a cost-effective treatment for patients who are unwilling or unable to adhere to CPAP therapy.
Sadatsafavi
Mohsen
M
Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, BC, Canada.
Marra
Carlo A
CA
Ayas
Najib T
NT
Stradling
John
J
Fleetham
John
J
D000328:Adult; D045422:Continuous Positive Airway Pressure / Q000191:economics / Q000379:methods; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009968:Orthodontic Appliances, Removable / Q000191:economics*; D015995:Prevalence; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000191:economics* / Q000628:therapy*; D012907:Smoking / Q000453:epidemiology; D020521:Stroke / Q000401:mortality