IS SYSTEMATIC OBSTRUCTIVE SLEEP APNEA SCREENING COST-EFFECTIVE AFTER ATRIAL FIBRILLATION ABLATION? A TRIAL-BASED ECONOMIC EVALUATION FROM THE SAAFIR RANDOMIZED TRIAL
Author(s)
hana Allouch chaabane, PharmD, nze ossima arnaud, PhD, Isabelle Durand-Zaleski, MPP, PhD, MD.
DRCI- Health economics, Assistance Publique-Hôpitaux de Paris, Hôpital de l’Hôtel Dieu, Paris, France.
DRCI- Health economics, Assistance Publique-Hôpitaux de Paris, Hôpital de l’Hôtel Dieu, Paris, France.
OBJECTIVES: Obstructive sleep apnea (OSA) is common and frequently undiagnosed in patients with atrial fibrillation (AF). We evaluated the cost-effectiveness of systematic OSA screening followed by treatment when indicated versus usual care without systematic OSA screening in patients undergoing AF ablation.
METHODS: A trial-based cost-effectiveness analysis was conducted alongside SAAFIR, a multicenter randomized controlled trial (n=277), from the French healthcare-provider perspective over 24 months (2026€). Direct medical costs (index ablation, rehospitalizations, cardiovascular and sleep specialist follow-up, medications, and OSA screening and treatment) were estimated using French national unit-cost schedules, hospital discharge data, and trial electronic case report forms. QALYs were derived from the EQ-5D-5L using the French value set. Missing data were handled by multiple imputation, and censored costs and QALYs due to incomplete follow-up were addressed using the inverse-probability-of-censoring weighting estimator of Bang and Tsiatis. Incremental cost-effectiveness ratios were expressed as the cost per QALY gained and per additional AF recurrence-free month; uncertainty was assessed using non-parametric bootstrapping.
RESULTS: Mean total costs were €20,350 in the screening group and €19,544 in the usual-care group, yielding an adjusted incremental cost of €806 (95% CI: −€2,290 to €3,904). The incremental QALY gain was 0.005 (95% CI −0.09 to 0.11); because it was close to zero, the cost-per-QALY ICER was uninformative. The difference in AF recurrence-free survival was 1.21 months (95% CI −0.42 to 2.84), corresponding to €666 per additional recurrence-free month. Bootstrap analyses showed substantial uncertainty: screening was favored in 54.5% of replicates on the QALY scale and 93.7% on AF recurrence-free survival.
CONCLUSIONS: In patients undergoing AF ablation, systematic OSA screening followed by treatment when indicated was associated with higher healthcare costs and a small difference in QALYs over 24 months compared with usual care. Further evaluation over a longer time horizon is warranted.
METHODS: A trial-based cost-effectiveness analysis was conducted alongside SAAFIR, a multicenter randomized controlled trial (n=277), from the French healthcare-provider perspective over 24 months (2026€). Direct medical costs (index ablation, rehospitalizations, cardiovascular and sleep specialist follow-up, medications, and OSA screening and treatment) were estimated using French national unit-cost schedules, hospital discharge data, and trial electronic case report forms. QALYs were derived from the EQ-5D-5L using the French value set. Missing data were handled by multiple imputation, and censored costs and QALYs due to incomplete follow-up were addressed using the inverse-probability-of-censoring weighting estimator of Bang and Tsiatis. Incremental cost-effectiveness ratios were expressed as the cost per QALY gained and per additional AF recurrence-free month; uncertainty was assessed using non-parametric bootstrapping.
RESULTS: Mean total costs were €20,350 in the screening group and €19,544 in the usual-care group, yielding an adjusted incremental cost of €806 (95% CI: −€2,290 to €3,904). The incremental QALY gain was 0.005 (95% CI −0.09 to 0.11); because it was close to zero, the cost-per-QALY ICER was uninformative. The difference in AF recurrence-free survival was 1.21 months (95% CI −0.42 to 2.84), corresponding to €666 per additional recurrence-free month. Bootstrap analyses showed substantial uncertainty: screening was favored in 54.5% of replicates on the QALY scale and 93.7% on AF recurrence-free survival.
CONCLUSIONS: In patients undergoing AF ablation, systematic OSA screening followed by treatment when indicated was associated with higher healthcare costs and a small difference in QALYs over 24 months compared with usual care. Further evaluation over a longer time horizon is warranted.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE465
Topic
Economic Evaluation, Methodological & Statistical Research, Patient-Centered Research
Topic Subcategory
Trial-Based Economic Evaluation
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)