title: A health-economic analysis of diagnosis and treatment of obstructive sleep apnea with continuous positive airway pressure in relation to cardiovascular disease. The Greek experience.
abstract: OBJECTIVE
  Obstructive sleep apnea syndrome (OSAS) is common in adult population and it is associated with increased morbidity and mortality, especially due to cardiovascular disease (CVD). Both diagnosis, based on polysomnography, and treatment with continuous positive airway pressure (CPAP), carry a potentially high cost. The present study aims to analyze the cost-effectiveness of CPAP treatment versus no treatment, in the long-term, as it examines the effect of this treatment on the incidence of CVD.
  
  
  METHODS
  A Markov model was constructed to observe the disease evolution in patients with OSAS based on published evidence. Data on treatment costs were collected from public hospitals in Greece. Within each cycle of the model, each patient may remain free of CVD, may develop CVD, may die due to a cause related to CVD, or may die from other causes. The model begins at the age of 55 years in a severe OSAS patient (apnea-hypopnea index ≥30/h) and lasts for 45 years.
  
  
  RESULTS
  Within the limitation of the model, CPAP was found to be a cost-effective strategy versus no treatment, due to the reduction of the cost for the CVD treatment, when the analysis was restricted to the male population. Moreover, CPAP was found to be clinically more effective than no treatment, as it increases life expectancy in both males and females.
  
  
  CONCLUSIONS
  CPAP was found to be clinically more effective therapy than no treatment in relation to CVD and a cost-effective strategy in males with severe OSAS.
authors.affiliation: Department of Clinical Therapeutics, Division of Pulmonology, Medical School, National University of Athens, Athens, Greece.
authors.forename: Georgia
authors.initials: G
authors.lastname: Trakada
authors.forename: Nicholas-Tiberio
authors.initials: NT
authors.lastname: Economou
authors.forename: Evangelia
authors.initials: E
authors.lastname: Nena
authors.forename: Athanasia
authors.initials: A
authors.lastname: Trakada
authors.forename: Pavlos
authors.initials: P
authors.lastname: Zarogoulidis
authors.forename: Paschalis
authors.initials: P
authors.lastname: Steiropoulos
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D045422:Continuous Positive Airway Pressure / Q000191:economics*; D003362:Cost-Benefit Analysis / Q000191:economics; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis / Q000191:economics / Q000628:therapy; D005260:Female; D006115:Greece; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D017286:Polysomnography / Q000191:economics; D019057:Quality-Adjusted Life Years; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*