title: A Bayesian cost-effectiveness analysis of a telemedicine-based strategy for the management of sleep apnoea: a multicentre randomised controlled trial.
abstract: BACKGROUND
  Compliance with continuous positive airway pressure (CPAP) therapy is essential in patients with obstructive sleep apnoea (OSA), but adequate control is not always possible. This is clinically important because CPAP can reverse the morbidity and mortality associated with OSA. Telemedicine, with support provided via a web platform and video conferences, could represent a cost-effective alternative to standard care management.
  
  
  OBJECTIVE
  To assess the telemedicine impact on treatment compliance, cost-effectiveness and improvement in quality of life (QoL) when compared with traditional face-to-face follow-up.
  
  
  METHODS
  A randomised controlled trial was performed to compare a telemedicine-based CPAP follow-up strategy with standard face-to-face management. Consecutive OSA patients requiring CPAP treatment, with sufficient internet skills and who agreed to participate, were enrolled. They were followed-up at 1, 3 and 6 months and answered surveys about sleep, CPAP side effects and lifestyle. We compared CPAP compliance, cost-effectiveness and QoL between the beginning and the end of the study. A Bayesian cost-effectiveness analysis with non-informative priors was performed.
  
  
  RESULTS
  We randomised 139 patients. At 6 months, we found similar levels of CPAP compliance, and improved daytime sleepiness, QoL, side effects and degree of satisfaction in both groups. Despite requiring more visits, the telemedicine group was more cost-effective: costs were lower and differences in effectiveness were not relevant.
  
  
  CONCLUSIONS
  A telemedicine-based strategy for the follow-up of CPAP treatment in patients with OSA was as effective as standard hospital-based care in terms of CPAP compliance and symptom improvement, with comparable side effects and satisfaction rates. The telemedicine-based strategy had lower total costs due to savings on transport and less lost productivity (indirect costs).
  NCT01716676.
authors: Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
authors: Valentina
authors: V
authors: Isetta
authors: Departamento de Métodos Cuantitativos y TiDES Institute, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Islas Canarias, Spain.
authors: Miguel A
authors: MA
authors: Negrín
authors: Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain Unidad del Sueño, Servicio de Neumología, Hospital Universitario de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain.
authors: Carmen
authors: C
authors: Monasterio
authors: Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres, Spain.
authors: Juan F
authors: JF
authors: Masa
authors: Unidad del Sueño, Hospital Universitario Reina Sofía, Universidad de Córdoba, IMIBIC, Córdoba, Spain.
authors: Nuria
authors: N
authors: Feu
authors: Unidad Funcional de Sueño, Hospital Universitario Araba, Vitoria-Gasteiz, Spain.
authors: Ainhoa
authors: A
authors: Álvarez
authors: Servicio de Neumología, Hospital Universitario de Valme, Sevilla, Spain.
authors: Francisco
authors: F
authors: Campos-Rodriguez
authors: Servicio de Neumología, Unidad del Sueño, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain.
authors: Concepción
authors: C
authors: Ruiz
authors: Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain Servicio de Neumología, Hospital Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain.
authors: Jorge
authors: J
authors: Abad
authors: Departamento de Métodos Cuantitativos y TiDES Institute, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Islas Canarias, Spain.
authors: Francisco J
authors: FJ
authors: Vázquez-Polo
authors: Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
authors: Ramon
authors: R
authors: Farré
authors: Servicio de Neumología, Hospital Universitario Sagrat Cor, Universidad de Barcelona, Barcelona, Spain.
authors: Marina
authors: M
authors: Galdeano
authors: Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain Servicio de Neumología, Unidad del Sueño, Hospital Universitario Vall d´Hebron, Barcelona, Spain.
authors: Patricia
authors: P
authors: Lloberes
authors: Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain Servicio de Neumología, Unidad del Sueño, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain.
authors: Cristina
authors: C
authors: Embid
authors: Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain Servicio de Neumología, Hospital Universitario Son Espases, IdisPa, Palma de Mallorca, Spain.
authors: Mónica
authors: M
authors: de la Peña
authors: Departamento de Neurofisiología Clínica y Unidad del Sueño, Hospital Universitario La Ribera, Alzira, Valencia, Spain Departamento de Fisiología, Universidad de Valencia, Valencia, Spain.
authors: Javier
authors: J
authors: Puertas
authors: Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain Servicio de Neumología, Unidad del Sueño, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain.
authors: Mireia
authors: M
authors: Dalmases
authors: Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain Unidad del Sueño, Servicio de Neumología, Hospital Universitario de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain.
authors: Neus
authors: N
authors: Salord
authors: Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres, Spain.
authors: Jaime
authors: J
authors: Corral
authors: Unidad del Sueño, Hospital Universitario Reina Sofía, Universidad de Córdoba, IMIBIC, Córdoba, Spain.
authors: Bernabé
authors: B
authors: Jurado
authors: Servicio de Neumología, Unidad del Sueño, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain.
authors: Carmen
authors: C
authors: León
authors: Unidad Funcional de Sueño, Hospital Universitario Araba, Vitoria-Gasteiz, Spain.
authors: Carlos
authors: C
authors: Egea
authors: Servicio de Neumología, Hospital Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain.
authors: Aida
authors: A
authors: Muñoz
authors: Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain Servicio de Neumología, Hospital Universitario Sagrat Cor, Universidad de Barcelona, Barcelona, Spain.
authors: Olga
authors: O
authors: Parra
authors: Servicio de Neumología, Unidad del Sueño, Hospital Universitario Vall d´Hebron, Barcelona, Spain.
authors: Roser
authors: R
authors: Cambrodi
authors: Departamento de Métodos Cuantitativos y TiDES Institute, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Islas Canarias, Spain.
authors: María
authors: M
authors: Martel-Escobar
authors: Servicio de Neumología, Hospital Universitario Son Espases, IdisPa, Palma de Mallorca, Spain.
authors: Meritxell
authors: M
authors: Arqué
authors: Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain Servicio de Neumología, Unidad del Sueño, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain.
authors: Josep M
authors: JM
authors: Montserrat
mesh_terms: D001499:Bayes Theorem; D045422:Continuous Positive Airway Pressure / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data; D011446:Prospective Studies; D011788:Quality of Life; D012890:Sleep; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D017216:Telemedicine / Q000191:economics / Q000379:methods*
keywords: Sleep apnoea