医学
持续气道正压
阻塞性睡眠呼吸暂停
质量调整寿命年
不错
呼吸不足
成本效益
成本效益分析
增量成本效益比
心理干预
物理疗法
生活质量(医疗保健)
急诊医学
多导睡眠图
儿科
呼吸暂停
内科学
程序设计语言
护理部
精神科
风险分析(工程)
计算机科学
作者
Helen Weatherly,Susan Griffin,Catriona Mc Daid,Kate H. Durée,Robert J. O. Davies,John Stradling,Marie Westwood,Mark Sculpher
出处
期刊:International Journal of Technology Assessment in Health Care
[Cambridge University Press]
日期:2009-01-01
卷期号:25 (01): 26-34
被引量:44
标识
DOI:10.1017/s0266462309090047
摘要
Objectives: An important option for the medical treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS) is continuous positive airway pressure (CPAP) during sleep. This study reports on the cost-effectiveness of CPAP compared with dental devices and lifestyle advice. The work was commissioned by the NHS HTA Programme to inform the National Institute of Health and Clinical Excellence's (NICE) appraisal of CPAP. Methods: A Markov model compared the interventions over the expected patient lifetime. The primary measure of cost-effectiveness was the incremental cost per quality-adjusted life-year (QALY) gained. The QALY incorporated the impact of treatments on daytime sleepiness, blood pressure and health-related quality of life (HRQoL). Results: On average, CPAP was associated with higher costs and QALYs compared with dental devices or lifestyle advice. In the base-case analysis, the incremental cost-effectiveness ratio (ICER) for CPAP compared with dental devices was around £4,000 per QALY (2005–06 prices). The probability that CPAP is more cost-effective than dental devices or lifestyle advice at a threshold value of £20,000 per QALY was 0.78 for men and 0.80 for women. Several sensitivity analyses were undertaken and it was found that the ICER for CPAP consistently fell below £20,000 per QALY gained, apart from in a subgroup with mild disease. Conclusions: The model suggests that CPAP is cost-effective compared with dental devices and lifestyle advice for adults with moderate or severe symptomatic OSAHS at the cost-effectiveness thresholds used by NICE. This finding is reflected in the NICE guidance.
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