title: Exploring the Potential Cost-Effectiveness of Patient Decision Aids for Use in Adults with Obstructive Sleep Apnea: A Case Study.
abstract: There is increasing evidence highlighting the effectiveness of patient decision aids (PtDAs), but evidence supporting their cost-effectiveness is lacking. We consider patients with obstructive sleep apnea (OSA), in whom a PtDA may decrease nonadherence to treatment by empowering patients to receive the option that is most congruent with their own values.
  
  
  
  To determine the potential costs and benefits of delivering a PtDA to patients with moderate OSA.
  
  
  
  A Markov cohort decision-analytic model was developed for patients with moderate OSA, comparing a PtDA to usual care over 5 years from a societal perspective. Data for patient preference for treatment options was taken from a recent randomized crossover trial, event data (cardiovascular, motor vehicle accidents) came from national databases and published literature. Potential improvements in adherence are unknown, so we considered a realistic range of values. Outcome measures were 5-year costs (in 2010 Canadian dollars), quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER).
  
  
  
  When adherence to treatment was unchanged, the PtDA strategy was dominated by incurring lower QALYs and higher costs. When nonadherence was decreased by 20% in the PtDA arm (corresponding to an increase in adherence from 63% to 70% for continuous positive airway pressure and from 77% to 82% for mandibular advancement splints in year 1), the ICER fell to $62,414/QALY. Costs associated with the treatment devices and delivering the PtDA had the greatest effect on cost-effectiveness.
  
  
  
  The model relies on surrogate measures and opinions for key parameters.
  
  
  
  The cost-effectiveness of PtDAs will depend on contextual factors, but a framework is described for properly considering their long-term cost-effectiveness. A number of important questions around the appropriateness of benefit measurement for PtDA trials are highlighted.
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, Canada (LT,NB)|Center for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada (LT, MS, NA, NB)|Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (LT, NA, LL, CM, NB)|Ottawa Hospital Research Institute, Ottawa, Canada (LT, DS)
authors.forename: Logan
authors.initials: L
authors.lastname: Trenaman
authors.affiliation: Center for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada (LT, MS, NA, NB)
authors.forename: Mohsen
authors.initials: M
authors.lastname: Sadatsafavi
authors.affiliation: Faculty of Dentistry, University of British Columbia, Vancouver, Canada (FA)
authors.forename: Fernanda
authors.initials: F
authors.lastname: Almeida
authors.affiliation: Center for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada (LT, MS, NA, NB)
authors.forename: Najib
authors.initials: N
authors.lastname: Ayas
authors.affiliation: Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (LT, NA, LL, CM, NB)|Collaboration for Outcomes Research and Evaluations, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada (MS, LL, CM)
authors.forename: Larry
authors.initials: L
authors.lastname: Lynd
authors.affiliation: Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (LT, NA, LL, CM, NB)|Collaboration for Outcomes Research and Evaluations, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada (MS, LL, CM)|Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada (NA)School of Pharmacy, Memorial University, St. John's, Canada (CM)
authors.forename: Carlo
authors.initials: C
authors.lastname: Marra
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Canada (LT, DS)|School of Nursing, University of Ottawa, Ottawa, Canada (DS).
authors.forename: Dawn
authors.initials: D
authors.lastname: Stacey
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, Canada (LT,NB)|Center for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada (LT, MS, NA, NB)|Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (LT, NA, LL, CM, NB)
authors.forename: Nick
authors.initials: N
authors.lastname: Bansback
mesh_terms: D000328:Adult; D002170:Canada; D045422:Continuous Positive Airway Pressure / Q000191:economics*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D010349:Patient Compliance; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D020181:Sleep Apnea, Obstructive / Q000191:economics* / Q000628:therapy
keywords: cost-effectiveness analysis; decision aids, patient decision making; economics