Guest J F, Helter M T, Morga A, Stradling J R
Catalyst Health Economics Consultants, 34b High Street, Northwood, Middlesex HA6 1BN, UK.
Thorax. 2008 Oct;63(10):860-5. doi: 10.1136/thx.2007.086454. Epub 2008 Apr 11.
A study was undertaken to estimate the cost-effectiveness of using continuous positive airway pressure (CPAP) in the management of patients with severe obstructive sleep apnoea/hypopnoea syndrome (OSAHS) compared with no treatment from the perspective of the UK's National Health Service (NHS).
A Markov model was constructed to assess the cost-effectiveness of CPAP compared with no treatment. The model depicted the management of a 55-year-old patient with severe OSAHS as defined by an apnoea-hypopnoea index (AHI) >30 and daytime sleepiness (Epworth Sleepiness Scale score >or=12). The model spans a period of 14 years.
According to the model, 57% of untreated patients are expected to be alive at the end of 14 years compared with 72% of patients treated with CPAP. Untreated patients are expected to cost the NHS pound10 645 (95% CI pound7988 to pound14,098) per patient over 14 years compared with pound9672 (95% CI pound8057 to pound12,860) per CPAP-treated patient. Treatment with CPAP for a period of 1 year was found not to be a cost-effective option since the cost per quality-adjusted life year (QALY) gained is expected to be > pound20,000, but after 2 years of treatment the cost per QALY gained is expected to be pound10,000 or less and, after 13 years of treatment, CPAP becomes a dominant treatment (ie, more effective than no treatment for less cost).
Within the limitations of the model, CPAP was found to be clinically more effective than no treatment and, from the perspective of the UK's NHS, a cost-effective strategy after a minimum of 2 years of treatment.
开展一项研究，从英国国家医疗服务体系（NHS）的角度评估与不治疗相比，使用持续气道正压通气（CPAP）治疗重度阻塞性睡眠呼吸暂停/低通气综合征（OSAHS）患者的成本效益。
构建马尔可夫模型以评估CPAP与不治疗相比的成本效益。该模型描述了一名55岁重度OSAHS患者的治疗情况，其呼吸暂停低通气指数（AHI）>30且有日间嗜睡（爱泼华嗜睡量表评分≥12）。模型涵盖14年时间。
根据模型，预计14年末未治疗患者的生存率为57%，而接受CPAP治疗患者的生存率为72%。预计14年间，未治疗患者每人将使NHS花费10645英镑（95%可信区间为7988英镑至14098英镑），而接受CPAP治疗的患者每人花费9672英镑（95%可信区间为8057英镑至12860英镑）。发现CPAP治疗1年不是一个具有成本效益的选择，因为每获得一个质量调整生命年（QALY）的成本预计>20000英镑，但治疗2年后，每获得一个QALY的成本预计为10000英镑或更低，且治疗13年后，CPAP成为优势治疗（即，比不治疗更有效且成本更低）。
在模型的局限性范围内，发现CPAP在临床上比不治疗更有效，并且从英国NHS的角度来看，至少治疗2年后是一种具有成本效益的策略。
