Mattila Tiina, Kreivi Hanna-Riikka, Mäkitalo Laura, Kotanen Petra, Avellan-Hietanen Heidi, Kauppi Paula
Department of Pulmonary Diseases, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Meilahti Triangle Hospital, Helsinki, Finland.
Eur Clin Respir J. 2025 Jun 19;12(1):2518663. doi: 10.1080/20018525.2025.2518663. eCollection 2025.
Obstructive sleep apnoea (OSA) is an increasing global public health problem. The primary treatment option is continuous positive airway pressure (CPAP). The cost-effectiveness of CPAP in patients with OSA is incompletely characterized.
For this scoping review, we conducted a PubMed search for cost-effectiveness analysis of CPAP treatment in European countries with tax-funded healthcare systems and for clinical practices to reduce costs of CPAP without reducing treatment quality. OSA severity was classified by the overnight apnoea-hypopnea index (AHI). The primary outcome was to define the cost-effectiveness of CPAP in high-income European countries with tax-funded healthcare systems. The second outcome was to describe possible clinical practices that may reduce costs of CPAP for patients with OSA without reducing CPAP treatment quality.
CPAP is a cost-effective treatment for those with severe or moderate OSA with symptoms, especially for middle-aged and overweight males. However, the cost-effectiveness remains unclear in mild OSA or moderate OSA without disabling sleepiness. Although CPAP adherence affects cost-effectiveness, this was not considered in all cost-effectiveness studies. The cost of CPAP treatment can be reduced, for instance, by choosing overnight polygraphy at home for diagnostics, remote contacts, nurse- and primary care-led follow-up, and by evaluating the number of necessary healthcare contacts for CPAP.
CPAP seems to be cost-effective and should be initiated at least for those with severe OSA or moderate OSA with symptoms. CPAP adherence should be considered in cost-effectiveness studies. There are clinical practices that can reduce CPAP treatment costs without reducing treatment quality.
阻塞性睡眠呼吸暂停（OSA）是一个日益严重的全球公共卫生问题。主要治疗选择是持续气道正压通气（CPAP）。CPAP治疗OSA患者的成本效益尚未完全明确。
对于本范围综述，我们在PubMed上搜索了对欧洲有税收资助医疗体系国家中CPAP治疗的成本效益分析，以及旨在降低CPAP成本同时不降低治疗质量的临床实践。OSA严重程度通过夜间呼吸暂停低通气指数（AHI）分类。主要结果是确定在有税收资助医疗体系的高收入欧洲国家中CPAP的成本效益。第二个结果是描述可能降低OSA患者CPAP成本且不降低CPAP治疗质量的临床实践。
CPAP对于有症状的重度或中度OSA患者是一种具有成本效益的治疗方法，尤其对于中年和超重男性。然而，在轻度OSA或无致残性嗜睡的中度OSA中，成本效益仍不明确。尽管CPAP依从性会影响成本效益，但并非所有成本效益研究都考虑了这一点。例如，通过选择在家进行夜间多导睡眠图诊断、远程联系、由护士和初级保健主导的随访，以及评估CPAP所需的医疗接触次数，可以降低CPAP治疗成本。
CPAP似乎具有成本效益，至少对于重度OSA或有症状的中度OSA患者应启动该治疗。在成本效益研究中应考虑CPAP依从性。存在一些可降低CPAP治疗成本且不降低治疗质量的临床实践。
