title: Long-Term Cost-Effectiveness of Upper Airway Stimulation for the Treatment of Obstructive Sleep Apnea: A Model-Based Projection Based on the STAR Trial.
abstract: OBJECTIVE
  Upper airway stimulation (UAS) is a new approach to treat moderate-to-severe obstructive sleep apnea. Recently, 12-month data from the Stimulation Treatment for Apnea Reduction (STAR) trial were reported, evaluating the effectiveness of UAS in patients intolerant or non-adherent to continuous positive airway pressure therapy. Our objective was to assess the cost-effectiveness of UAS from a U.S. payer perspective.
  
  
  METHODS
  A 5-state Markov model was used to predict cardiovascular endpoints (myocardial infarction [MI], stroke, hypertension), motor vehicle collisions (MVC), mortality, quality-adjusted life years (QALYs), and costs. We computed 10-year relative event risks and the lifetime incremental cost-effectiveness ratio (ICER) in $/QALY, comparing UAS therapy to no treatment under the assumption that the STAR trial-observed reduction in mean apnea-hypopnea index from 32.0 to 15.3 events/h was maintained. Costs and effects were discounted at 3% per year.
  
  
  METHODS
  U.S. healthcare system; third-party payer perspective.
  
  
  METHODS
  83% male cohort with mean age of 54.5 years.
  
  
  METHODS
  UAS vs. no treatment.
  
  
  RESULTS
  UAS substantially reduced event probabilities over 10 years (relative risks: MI 0.63; stroke 0.75; MVC 0.34), and was projected to add 1.09 QALYs over the patient's lifetime. Costs were estimated to increase by $42,953, resulting in a lifetime ICER of $39,471/QALY.
  
  
  CONCLUSIONS
  Relative to the acknowledged willingness-to-pay threshold of $50,000-$100,000/QALY, our results indicate upper airway stimulation is a cost-effective therapy in the U.S. healthcare system.
authors.affiliation: Wing Tech Inc., Menlo Park, CA.
authors.forename: Jan B
authors.initials: JB
authors.lastname: Pietzsch
authors.affiliation: Wing Tech Inc., Menlo Park, CA.|University of Washington, Seattle, WA.
authors.forename: Shan
authors.initials: S
authors.lastname: Liu
authors.affiliation: Wing Tech Inc., Menlo Park, CA.
authors.forename: Abigail M
authors.initials: AM
authors.lastname: Garner
authors.affiliation: Keck School of Medicine of the University of Southern California, Los Angeles, CA.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Kezirian
authors.affiliation: University of Pittsburgh, PA.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Strollo
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000453:epidemiology; D019057:Quality-Adjusted Life Years; D012306:Risk; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D020521:Stroke / Q000150:complications / Q000453:epidemiology
keywords: cost effectiveness; hypoglossal nerve; implantable neurostimulators; obstructive sleep apnea; upper airway stimulation