SLEEP APNOEA (2007)

Continuous positive airway pressure devices for the treatment of obstructive sleep apnoea-hypopnoea syndrome: a systematic review and economic analysis

Background

Obstructive sleep apnoea/hypopnoea syndrome (OSAHS) is the reduction or cessation of breathing during sleep due to narrowing or occlusion of the upper airway. Affected individuals are awakened partially or fully by the reflex to breathe. This results in excessive daytime sleepiness. This review investigated the clinical effectiveness and cost-effectiveness of machines that deliver continuous positive airways pressure through a mask.

Findings

CPAP is an effective treatment for OSAHS compared with conservative/usual care and placebo in populations with moderate to severe daytime sleepiness and there may be benefits where the disease is mild. Dental devices may be a treatment option in moderate disease but some uncertainty remains. Further investigation of the effectiveness of CPAP for populations with mild sleepiness is required and further trials comparing CPAP to dental devices may be useful. Investigation of the effect of CPAP on hypertension would be beneficial, particularly with respect to what populations might be expected to benefit, as well as trials adequately powered to identify changes in CVE.

On average CPAP was associated with higher costs and higher benefits compared to conservative management. The incremental cost per QALY gained of CPAP was below £20,000 in the base-case analysis and most alternative scenarios. There was a high probability of CPAP being more cost-effective than dental devices and conservative management for a cost-effectiveness threshold of £20,000 per QALY gained. The expected value of further information calculated in the York economic model indicates that further research to reduce the uncertainty in the current evidence base would be potentially valuable.

Conducted by: C McDaid1, S Griffin2, H Weatherly2, K Durée1, M van der Burgt2, S van Hout2, J Akers1, RJO Davies3, M Sculpher2, M Westwood1

1. Centre for Reviews and Dissemination; 2. Centre for Health Economics, University of York; 3. Oxford Centre for Respiratory Medicine, Oxford Radcliffe Hospital

Further details

Project page on HTA Programme website

Related guidance

Commissioned to inform NICE Technology Appraisal Guidance 139: Continuous positive airway pressure for the treatment of obstructive sleep apnoea/hypopnoea syndrome. London: National Institute for Clinical Excellence; 2008

Publications

McDaid C, Griffin S, Weatherley H, Duree K, van der Burgt, van Hout S, Akers J, Davies RJO, Sculpher M, Westwood M. Continuous positive airway pressure devices for the treatment of obstructive sleep apnoea-hypopnoea syndrome: a systematic review and economic analysis. Health Technol Assess. 2009; 13(4): 1-274

McDaid C, Duree KH, Griffin SC, Weatherley HLA, Stradling JR, Davies RJO, Sculpher MJ, Westwood ME. A systematic review of continuous positive airway pressure for obstructive sleep apnoea-hypopnoea syndrome. Sleep Med Rev. 2009; 13(6):427-36

Weatherley HLA, Griffin SC, McDaid C, Duree KH, Davies RJO, Stradling JR, Westwood ME, Sculpher ME. An economic analysis of continuous positive airway pressure for the treatment of obstructive sleep apnoea syndrome. Int J Technol Assess Health Care. 2009; 25(1): 26-34

Funding

Commissioned by the HTA Programme on behalf of NICE's Technology Assessment Report (TAR) process