Sleep apnoea syndrome: the health economics point of view.

This review analyses the available literature on the economic aspects of obstructive sleep apnoea, including the indirect medical costs, the indirect nonmedical costs, the direct costs of diagnosing and treating the disease, and the utilities as perceived by patients. The philosophical context of health economics is also considered. The literature available on the economic aspects of obstructive sleep apnoea is scarce, and frequently incomplete, so that only tentative conclusions can be reached. Obstructive sleep apnoea seems to lead to measurable (about two-fold) increases in indirect medical costs. Moreover, this excess cost seems to be reduced in the first years following the institution of treatment with nasal continuous positive airway pressure (nCPAP). There are also indirect nonmedical costs linked to the disease, for example traffic, domestic and workplace accidents. The exact extent of these costs is, however, impossible to ascertion from the available literature. Cost/utility analysis has shown full-night polysomnography to be the diagnostic approach with the higher cost/utility ratio, because diagnostic errors (greater with other approaches) carry a disproportionate weight. The cost of treating the disease has not been thoroughly assessed but appears as quite reasonable, and certainly not excessive. Finally, one study has shown in patients with severe sleep apnoea that treatment with nCPAP has a favourable effect when measured as quality adjusted life years. It is concluded that obstructive sleep apnoea leads to an excess in health-related expenditure, that treatment with nasal continuous positive airway pressure reduces this excess cost and thus makes sense in economic terms, and that patients believe nasal continuous positive airway pressure treatment to be worth considering for economic reasons. It is further concluded that medical decisions should be guided by medical (not economic) considerations, even if it is acknowledged that, for the time being, economic analysis is necessary to to convince health managers that obstructive sleep apnoea is also worth considering from the economic point of view.