Introduction:
Upper airway stimulation (UAS) is a treatment approach intended for patients with
medium-to-severe obstructive sleep apnea who have failed or cannot tolerate continuous
positive airway pressure therapy. Our objective was to evaluate the clinical and economic
benefit of UAS in the German social health insurance.
Methods:
A Markov model projected the probabilities of hypertension, myocardial infarction
(MI), stroke, and motor vehicle collisions (MVC) to estimate cardiovascular and all-cause
mortality, quality-adjusted life years (QALYs), and total direct costs for UAS versus
no treatment from a payer perspective. Baseline characteristics and treatment efficacy
were obtained from a German prospective observational study and literature. Ten-year
relative event risks (RR) and lifetime survival benefit were computed as well as well
as incremental cost-effectiveness ratios in Euros per QALY.
Results:
According to the observational study the patients' (mean age 57 years, BMI 29 kg/m2) apnea-hypopnea index was reduced from 31.2 to 13.8 events per hour by UAS compared
to no treatment. UAS reduced all types of events projected (ten-year RR for stroke,
MI, cardiovascular death, and MVC: 0.76, 0.64, 0.65, and 0.34, respectively) and increased
survival by 1.27 life years. While the UAS strategy incurred an additional 1.02 QALYs,
there were also additional mean costs of 54,578 Euros over the patient's lifetime,
resulting in an incremental cost-effectiveness ratio of € 53,698 per QALY gained.
Conclusions:
Upper airway stimulation adds meaningful benefit to endpoints relevant to obstructive
sleep apnea patients and is a cost-effective therapy for patients ineligible to continuous
positive pressure ventilation in the German healthcare setting.
