Mohsen Sadatsafavi & Carlo A. Marra & Najib T. Ayas & John Stradling & John FleethamReceived: 3 December 2008 / Revised: 13 January 2009 / Accepted: 25 January 2009Springer-Verlag 2009
Oral appliances (OA) are commonly prescribed for the treatment of obstructive sleep apnea–hypopnea (OSAH), but there is limited evidence on their cost-effectiveness.
Materials and methods
A model was designed to simulate the costs and benefits of treatment of OSAH with OA or continuous positive airway pressure (CPAP) based on their effects on quality of life, motor vehicle crashes, and cardiovascular effects. The primary outcome was the incremental cost-effectiveness ratio (ICER) in terms of costs per one quality-adjusted life year (QALY) gained 5 years after treatment.
Compared with no treatment, OA results in $268 higher costs and an incremental QALY of 0.0899 per patient (ICER=$2,984/QALY). Compared with OA, CPAP resulted in $1,917 more costs and 0.0696 additional QALYs (ICER=$27,540/QALY).
Oral appliances (OA) are now widely prescribed for the treatment of OSAH, either as primary therapy or as an alternative for those unwilling or unable to tolerate CPAP. Though the CPAP has been shown to be more effective than OA, there is increasing evidence that OA improves sleepiness, blood pressure and the indices of sleep disordered breathing. In addition, many patients who respond to both treatments often prefer the use of an OA over CPAP.
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