The Impact of Treatments for OSA on Monetized Health Economic Outcomes: A Systematic Review

Chest: The Journal of Circulation, Respiration and Related Systems

Maxwell M. Towe^4¹  Samuel A. Abariga^3²  Samson Z. Assefa^7³  Emerson M. Wickwire^1,2⁴  Montserrat Diaz-Abad^2⁵  Andrea G. Shipper^5⁶  Jennifer S. Albrecht^3⁷  Liesl M. Cooper^6⁸ 

[1]Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD^3

[2]Department of Medicine, University of Maryland School of Medicine, Baltimore, MD^4

[3]Department of Neurology, Columbia University, New York, NY^8

[4]Department of Psychiatry, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland, Baltimore, MD^1

[5]Health Sciences and Human Services Library, University of Maryland, Baltimore, MD^5

[6]ResMed Corp, San Diego, CA^6

[7]Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland, Baltimore, MD^2

[8]Sleep Disorders Center, Fort Belvoir Community Hospital, Fort Belvoir, VA^7

关键词: accident risk;    CPAP;    economics;    health-care use;    sleep apnea;    sleep medicine;    treatment;    workplace productivity;    CEA;    cost-effectiveness analysis;    CUA;    cost-utility analysis;    HCU;    health-care use;    HF;    heart failure;    HrQOL;    health-related quality of life;    HSAT;    home sleep apnea testing;    MVC;    motor vehicle crash;    NOS;    Newcastle-Ottawa Scale;    OA;    oral appliance;    PAP;    positive airway pressure;    PSG;    polysomnography;    QALY;    quality-adjusted life year;    RCT;    randomized controlled trial;    SCD;    sickle cell disease;    UPPP;    uvulopalatopharyngoplasty;    USD;    US dollars;   

DOI  :  10.1016/j.chest.2019.01.009

学科分类：呼吸医学

来源: American College of Chest Physicians

【 摘 要 】

Objective To review systematically the published literature regarding the impact of treatment for OSA on monetized health economic outcomes. Methods Customized structured searches were performed in PubMed, Embase (Embase.com), and the Cochrane Central Register of Controlled Trials (Wiley) databases. Reference lists of eligible studies were also analyzed. Titles and abstracts were examined, and articles were identified for full-text review. Studies that met inclusion criteria were evaluated in detail, and study characteristics were extracted using a standardized template. Quantitative characteristics of the studies were summarized, and a qualitative synthesis was performed. Results Literature searches identified 2,017 nonredundant abstracts, and 196 full-text articles were selected for review. Seventeen studies met inclusion criteria and were included in the final synthesis. Seven studies included formal cost-effectiveness or cost-utility analyses. Ten studies employed cohort designs, and four studies employed randomized controlled trial or quasi-experimental designs. Positive airway pressure was the most common treatment modality, but oral appliances and surgical approaches were also included. The most common health economic outcomes were health-care use (HCU) and quality-adjusted life years (QALYs). Follow-ups ranged from 6 weeks to 5 years. Overall, 15 of 18 comparisons found that treatment of OSA resulted in a positive economic impact. Treatment adherence and OSA severity were positively associated with cost-effectiveness. Conclusions Although study methodologies varied widely, evidence consistently suggested that treatment of OSA was associated with favorable economic outcomes, including QALYs, within accepted ranges of cost-effectiveness, reduced HCU, and reduced monetized costs.

【 授权许可】

CC BY