title: COST-EFFECTIVENESS OF TREATMENTS FOR MILD-TO-MODERATE OBSTRUCTIVE SLEEP APNEA IN FRANCE.
abstract: OBJECTIVE
  Untreated obstructive sleep apnea-hypopnea syndrome (OSAHS) is associated with excessive daytime sleepiness, increased risk of cardiovascular (CV) disease, and road traffic accidents (RTAs), which impact survival and health-related quality of life. This study, funded by the French National Authority for Health (HAS), aimed to assess the cost-effectiveness of different treatments (i.e., continuous positive airway pressure [CPAP], dental devices, lifestyle advice, and no treatment) in patients with mild-to-moderate OSAHS in France.
  
  
  METHODS
  A Markov model was developed to simulate the progression of two cohorts, stratified by CV risk, over a lifetime horizon. Daytime sleepiness and RTAs were taken into account for all patients while CV events were only considered for patients with high CV risk.
  
  
  RESULTS
  For patients with low CV risk, incremental cost-effectiveness ratio (ICER) of dental devices versus no treatment varied between 32,976 EUR (moderate OSAHS) and 45,579 EUR (mild OSAHS) per quality-adjusted life-year (QALY), and CPAP versus dental devices, above 256,000 EUR/QALY. For patients with high CV risk, CPAP was associated with a gain of 0.62 QALY compared with no treatment, resulting in an ICER of 10,128 EUR/QALY.
  
  
  CONCLUSIONS
  The analysis suggests that it is efficient to treat all OSAHS patients with high CV risk with CPAP and that dental devices are more efficient than CPAP for mild-to-moderate OSAHS with low CV risk. However, out-of-pocket costs are currently much higher for dental devices than for CPAP (i.e., 3,326 EUR versus 2,430 EUR) as orthodontic treatment is mainly non-refundable in France.
authors.affiliation: Haute Autorité de Santé
authors.forename: Anne-Isabelle
authors.initials: AI
authors.lastname: Poullié
authors.affiliation: Amaris UK Ltd.cognet.magali@gmail.com.
authors.forename: Magali
authors.initials: M
authors.lastname: Cognet
authors.affiliation: Amaris UK Ltd.
authors.forename: Aline
authors.initials: A
authors.lastname: Gauthier
authors.affiliation: Amaris UK Ltd.
authors.forename: Marine
authors.initials: M
authors.lastname: Clementz
authors.affiliation: Amaris UK Ltd.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Druais
authors.affiliation: University Claude Bernard.
authors.forename: Hans-Martin
authors.initials: HM
authors.lastname: Späth
authors.affiliation: Cancer Centre Léon Bérard.
authors.forename: Lionel
authors.initials: L
authors.lastname: Perrier
authors.affiliation: Haute Autorité de Santé
authors.forename: Oliver
authors.initials: O
authors.lastname: Scemama
authors.affiliation: Haute Autorité de Santé
authors.forename: Catherine Rumeau
authors.initials: CR
authors.lastname: Pichon
authors.affiliation: Haute Autorité de Santé
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Harousseau
mesh_terms: D000063:Accidents, Traffic / Q000191:economics / Q000517:prevention & control; D002318:Cardiovascular Diseases / Q000191:economics* / Q000209:etiology / Q000517:prevention & control; D045422:Continuous Positive Airway Pressure / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D005260:Female; D005602:France / Q000453:epidemiology; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008019:Life Style; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D017059:Models, Econometric; D009064:Mouth Protectors / Q000191:economics*; D010349:Patient Compliance; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000401:mortality / Q000628:therapy*
keywords: Continuous positive airway pressure; Cost-effectiveness analysis; Dental devices; Obstructive sleep apnea