1. Efficacy and cost-effectiveness of home respiratory polygraphy
- Author
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Juan Fernando Masa Jiménez, Joaquín Terán Santos, Mónica Bravo, Ferran Barbé Illa, Neus Salord Oleo, Marta Cabello Najera, Francisco Capote Gil, José Carlos Serrano, Joaquín Durán Cantolla, Jesús Muñoz Méndez, Josep M. Montserrat, and Mª Ángeles Sanchez Quiroga
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,Cost effectiveness ,business.industry ,Polysomnography ,medicine.disease ,nervous system diseases ,respiratory tract diseases ,law.invention ,Obstructive sleep apnea ,Blood pressure ,Randomized controlled trial ,Quality of life ,law ,Ambulatory ,medicine ,Physical therapy ,Sleep study ,business - Abstract
Introduction Home respiratory polygraphy (HRP) is a cost-effectiveness choice to polysomnography (PSG) for diagnosis and treatment in patients with high obstructive sleep apnea (OSA) suspicion what includes 40% of patients needing sleep study. There is not randomized control trial (RCT) focus in the same objective including the entire population needing sleep study (intermediate-high OSA suspicion). Objectives Demonstrate if HRP is a non-inferior effective and a cost-effective alternative to PSG for diagnosis and treatment in most OSA suspicion patients. Method A multicentric, non-inferiority RCT included patients with intermediate-to-high OSA suspicion from 8 centers in Spain. Patients were randomized to be managed (diagnosis and treatment decision-marking) according to PSG or HRP results for 6 months of follow-up. Sleep and quality of life questionnaires, ambulatory 24 hours blood pressure monitoring, CPAP compliance, PSG at 6 months and side effects were collected. An Epworth scale inter-group difference less than -2 in the lower bound of 1-side 95% CI was the non-inferiority premise. QALYS changes were used in a Bayesian cost-effectiveness analysis. Results 430 patients were randomized. At 6 months, changes in the Epworth scale, EuroQol, SF36, FOSQ, analogical scale, PSG and blood pressure were similar between groups. Epworth scale non-inferiority premise was -0.24 adjusted by baseline values and sites. In the cost-effectiveness plane, HRP had similar effectiveness (QALYS different -0.0043) and 421€ lower cost than PSG. Conclusion In this large RCT, HRP was a clear cost-effectiveness alternative to PSG for management of most patients with OSA suspicion. Present results can decrease costs and waiting list across countries.
- Published
- 2016
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