ADDED BENEFIT OF UPPER AIRWAY STIMULATION FOR THE TREATMENT OF MODERATE TO SEVERE OBSTRUCTIVE SLEEP APNEA IN AUSTRIA
Author(s)
Pietzsch JB1, Zauner G2, Liu S1
1Wing Tech Inc., Irvine, CA, USA, 2dwh GmbH, Vienna, Austria
OBJECTIVES: Upper airway stimulation (UAS) is a novel device-based approach to treat moderate-to-severe obstructive sleep apnea. Data from the Stimulation Treatment for Apnea Reduction (STAR) trial suggest a long-term stable treatment effect of UAS among patients intolerant or non-compliant with CPAP therapy. Our objective was to estimate the added benefit of UAS therapy in a simulated cohort of Austrian patients. METHODS: A previously published Markov state-transition model based on multivariate risk equations and other published sources was populated with risk factors, lifetables, and baseline event rates for Austria. The model predicted cardiovascular disease (CVD) mortality, myocardial infarction (MI), stroke, motor vehicle collisions (MVC), and unadjusted and quality-adjusted survival. We computed 10-year relative event risks and lifetime survival gain for UAS compared to no treatment in a cohort with mean age of 54.5 years, under the assumption of a maintained reduction in mean apnea-hypopnea index (AHI) from 32.0 to 11.5 events/hour as observed in 3-year follow-up of the STAR trial. RESULTS: Over the 10-year horizon, UAS was projected to reduce risk of CVD death from 5.8% to 3.5% (RR: 0.60), MI from 12.7% to 7.5% (RR: 0.59), and stroke from 6.3% to 4.5% (RR: 0.71). MVC events were reduced from 12.6% to 4.2% (RR: 0.34). UAS treatment was projected to increase survival from 21.08 to 22.51 life years (+1.43 LYs), and to add 1.86 quality-adjusted life years over the patient’s lifetime (13.55 vs. 15.41 QALYs). Assuming a reduced treatment effect in line with 12-month STAR results (AHI 15.3), projected lifetime gains were 1.18 LYs and 1.54 QALYs. CONCLUSIONS: Our projection suggests that UAS treatment of patients with moderate-to-severe obstructive sleep apnea might lead to pronounced event risk reductions over the long run, and be associated with meaningful gains in unadjusted and quality-adjusted life expectancy for patients in Austria.
Conference/Value in Health Info
2016-10, ISPOR Europe 2016, Vienna, Austria
Value in Health, Vol. 19, No. 7 (November 2016)
Code
PMD10
Topic
Clinical Outcomes
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
Cardiovascular Disorders, Neurological Disorders