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.
