CLINICAL AND ECONOMIC BENEFIT OF UPPER AIRWAY STIMULATION FOR OBSTRUCTIVE SLEEP APNEA IN THE GERMAN SETTING
Author(s)
Pietzsch JB1, Weschenfelder A2, Randerath W3, Steffen A4, Liu S1, Geisler BP1, Wasem J2, Biermann J2
1Wing Tech Inc., Irvine, CA, USA, 2Universität Duisburg-Essen, Essen, Germany, 3Bethanien Hospital Solingen, Solingen, Germany, 4University Hospital Schleswig-Holstein, Lübeck, Germany
OBJECTIVES: 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 healthcare system. METHODS: A five-state Markov model projected the probabilities of hypertension, major adverse cardiovascular or cerebrovascular events (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 the German statutory health insurance perspective. Baseline characteristics and treatment efficacy were obtained from a recent prospective observational study and derived from literature via multivariate regression. Ten-year relative event risks (RR) and undiscounted lifetime survival benefit were computed as well as well as incremental cost-effectiveness ratios in Euros per QALY, discounted at 3% for costs and effects. RESULTS: Based on a real-world study from Germany, the patients’ mean age at baseline was 57 years, their BMI was 29 kg/m, and their 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 relative risks 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.
Conference/Value in Health Info
2017-11, ISPOR Europe 2017, Glasgow, Scotland
Value in Health, Vol. 20, No. 9 (October 2017)
Code
PMD51
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies, Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Cardiovascular Disorders, Respiratory-Related Disorders