Date and Time
October 13, 2010
1:30 PM - 3:00 PM

Availability
Open to the public
No RSVP required

Please note: All research in progress seminars are off-the-record. Any information about methodology and/or results are embargoed until publication.

BACKGROUND. Obstructive sleep apnea (OSA) is a prevalent disorder and is associated with increased cardiovascular morbidity and mortality, as well as excessive daytime sleepiness and neurocognitive underperformance. Conventional nonsurgical OSA therapy necessitates indefinite continuous positive airway pressure (CPAP). Although CPAP is an effective OSA treatment modality, up to 50% of OSA patients are intolerant of and ultimately reject CPAP therapy. Several OSA surgical therapies have been developed for those intolerant of CPAP. We explore whether surgical modalities (i.e. uvulopalatopharyngoplasty (UPPP), multi-level surgery (MLS), maxillomandibular advancement (MMA)) or strategies (i.e. Phase Protocol - MLS first, followed by MMA for surgical failures) are cost-effective OSA therapies.

METHODS. We construct a lifetime semi-Markov model of OSA. This model accounts for observed increased risks of stroke, cardiovascular disease and motor vehicle collisions in those with untreated OSA.

RESULTS. CPAP is cost-effective over conservative treatment (no therapy) at an ICER of $200/QALY for a 30-year old male with severe OSA. Surgical options (i.e. UPPP, MLS, MMA) are also cost-effective over conservative treatment at ICERs ranging between $1500/QALY to $18,000/QALY. Comparing surgical options and phase protocol versus CPAP, we obtain ICERs of between $12,000/QALY to $40,000/QALY for the various surgical options assuming that surgery confers lifetime benefits. In sensitivity analysis, the ICER over CPAP for MMA increases from $40,000/QALY to $110,000/QALY if MMA's benefit is limited to 15 years. The ICER between MMA and Phase Protocol is heavily dependent on the success/cure rates of secondary MMA, the incremental utility of MMA as well as costs of surgery.

CONCLUSIONS: CPAP is a highly cost-effective OSA treatment modality. Most surgical options, including MMA appear cost-effective in CPAP intolerant individuals.