OBJECTIVES Obstructive sleep apnea (OSA) has been demonstrated to be a risk factor for several diseases and to be correlated with other non-medical consequences that increase OSA’s clinical and economic burden. The impact of OSA is often highly underestimated, also due to substantial diagnosis gaps. The study objective was to assess the societal economic burden of OSA in Italy, estimating also the economic consequences of undiagnosed and untreated OSA and assessing the benefits brought by higher diagnosis rates and more appropriate treatment pathway.

METHODS We performed a cost-of-illness analysis (COI) adopting the societal perspective. A systematic literature review on meta-analyses, integrated by expert opinion, was carried out to identify all clinical and non-clinical conditions significantly associated with OSA. Using the population attributable fraction methodology, a portion of their costs was attributed to OSA with a top-down approach. Different scenarios were simulated in order to estimate the impact of higher diagnosis and treatment on OSA economic burden.

RESULTS : 22 clinical (e.g. diabetes) and non-clinical (e.g. car accidents) conditions significantly associated with OSA were included in COI analysis. The economic burden due to conditions associated with OSA in Italy is substantial, around €31 billion/year (€520 per Italian resident). The cost of impaired quality of life due to OSA under treatment is approximately €9 billion/year. Scenario analysis revealed that Continuous Positive Airway Pressure (CPAP) treatment could generate potential savings in direct non-healthcare and productivity losses costs of conditions associated and a substantial gain in QALYs value, ultimately leading to increased value for the society.

CONCLUSIONS This study aimed at providing reliable estimates of the extent of OSA consequences. Results suggest that the burden of OSA is substantial, also due to low treatment rates. More appropriate diagnosis rates and clinical pathways for OSA patients are recommended in order to decrease the clinical and economic burden of disease.