Grietje E de Vries1,2, Aarnoud Hoekema3,4,5,6, Karin M Vermeulen7, Johannes Q P J Claessen8, Wouter Jacobs9, Jan van der Maten10, Johannes H van der Hoeven11, Boudewijn Stegenga3,12, Huib A M Kerstjens1,2, Peter J Wijkstra1,2,13. 1. Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, The Netherlands. 2. Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, The Netherlands. 3. Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, The Netherlands. 4. Department of Oral Kinesiology, Academic Center for Dentistry Amsterdam, MOVE Research Institute Amsterdam, University of Amsterdam and VU University Amsterdam, The Netherlands. 5. Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands. 6. Department of Oral and Maxillofacial Surgery, Tjongerschans Hospital Heerenveen, The Netherlands. 7. Department of Epidemiology, University of Groningen, University Medical Center Groningen, The Netherlands. 8. Department of Ear Nose and Throat surgery, Martini Hospital Groningen, The Netherlands. 9. Department of Pulmonary Diseases, Martini Hospital Groningen, The Netherlands. 10. Department of Pulmonary Diseases, Medical Center Leeuwarden, The Netherlands. 11. Department of Clinical Neurophysiology, University of Groningen, University Medical Center Groningen, The Netherlands. 12. Deceased October 27, 2018. 13. Center for Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, The Netherlands.
Abstract
STUDY OBJECTIVES: Limited evidence exists on the cost-effectiveness of mandibular advancement device (MAD) compared to continuous positive airway pressure (CPAP) therapy in moderate obstructive sleep apnea (OSA). Therefore, this study compares the clinical and cost-effectiveness of MAD therapy with CPAP therapy in moderate OSA. METHODS: In a multicentre randomized controlled trial, patients with an apnea-hypopnea index (AHI) of 15 to 30 events/h were randomized to either MAD or CPAP. Incremental cost-effectiveness and cost-utility ratios (ICER/ICUR, in terms of AHI reduction and quality-adjusted life-years [QALYs, based on the EuroQol Five-Dimension Quality of Life questionnaire]) were calculated after 12 months, all from a societal perspective. RESULTS: In the 85 randomized patients (n = 42 CPAP, n = 43 MAD), AHI reduction was significantly greater with CPAP (median reduction AHI 18.3 [14.8-22.6] events/h) than with MAD therapy (median reduction AHI 13.5 [8.5-18.4] events/h) after 12 months. Societal costs after 12 months were higher for MAD than for CPAP (mean difference €2.156). MAD was less cost-effective than CPAP after 12 months (ICER -€305 [-€3.003 to €1.572] per AHI point improvement). However, in terms of QALY, MAD performed better than CPAP after 12 months (€33.701 [-€191.106 to €562.271] per QALY gained). CONCLUSIONS: CPAP was more clinically effective (in terms of AHI reduction) and cost-effective than MAD. However, costs per QALY was better with MAD as compared to CPAP. Therefore, CPAP is the first-choice treatment option in moderate OSA and MAD may be a good alternative. CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Identifier: NCT01588275.
RCT Entities:
STUDY OBJECTIVES: Limited evidence exists on the cost-effectiveness of mandibular advancement device (MAD) compared to continuous positive airway pressure (CPAP) therapy in moderate obstructive sleep apnea (OSA). Therefore, this study compares the clinical and cost-effectiveness of MAD therapy with CPAP therapy in moderate OSA. METHODS: In a multicentre randomized controlled trial, patients with an apnea-hypopnea index (AHI) of 15 to 30 events/h were randomized to either MAD or CPAP. Incremental cost-effectiveness and cost-utility ratios (ICER/ICUR, in terms of AHI reduction and quality-adjusted life-years [QALYs, based on the EuroQol Five-Dimension Quality of Life questionnaire]) were calculated after 12 months, all from a societal perspective. RESULTS: In the 85 randomized patients (n = 42 CPAP, n = 43 MAD), AHI reduction was significantly greater with CPAP (median reduction AHI 18.3 [14.8-22.6] events/h) than with MAD therapy (median reduction AHI 13.5 [8.5-18.4] events/h) after 12 months. Societal costs after 12 months were higher for MAD than for CPAP (mean difference €2.156). MAD was less cost-effective than CPAP after 12 months (ICER -€305 [-€3.003 to €1.572] per AHI point improvement). However, in terms of QALY, MAD performed better than CPAP after 12 months (€33.701 [-€191.106 to €562.271] per QALY gained). CONCLUSIONS: CPAP was more clinically effective (in terms of AHI reduction) and cost-effective than MAD. However, costs per QALY was better with MAD as compared to CPAP. Therefore, CPAP is the first-choice treatment option in moderate OSA and MAD may be a good alternative. CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Identifier: NCT01588275.
Authors: Michiel H J Doff; Aarnoud Hoekema; Peter J Wijkstra; Johannes H van der Hoeven; James J R Huddleston Slater; Lambert G M de Bont; Boudewijn Stegenga Journal: Sleep Date: 2013-09-01 Impact factor: 5.849
Authors: Sara Serra-Torres; Carlos Bellot-Arcís; José M Montiel-Company; Jaime Marco-Algarra; José M Almerich-Silla Journal: Laryngoscope Date: 2015-07-30 Impact factor: 3.325
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Authors: Grietje E de Vries; Aarnoud Hoekema; Johannes Q P J Claessen; Cornelis Stellingsma; Boudewijn Stegenga; Huib A M Kerstjens; Peter J Wijkstra Journal: J Clin Sleep Med Date: 2019-11-15 Impact factor: 4.062
Authors: Julia A M Uniken Venema; Grietje E Knol-de Vries; Harry van Goor; Johanna Westra; Aarnoud Hoekema; Peter J Wijkstra Journal: J Clin Sleep Med Date: 2022-06-01 Impact factor: 4.324