TY - JOUR
T1 - A Bayesian cost-effectiveness analysis of a telemedicine-based strategy for the management of sleep apnoea: A multicentre randomised controlled trial
AU - Isetta, Valentina
AU - Negrín, Miguel A.
AU - Monasterio, Carmen
AU - Masa, Juan F.
AU - Feu, Nuria
AU - Álvarez, Ainhoa
AU - Campos-Rodriguez, Francisco
AU - Ruiz, Concepción
AU - Abad, Jorge
AU - Vázquez-Polo, Francisco J.
AU - Farré, Ramon
AU - Galdeano, Marina
AU - Lloberes, Patricia
AU - Embid, Cristina
AU - De La Peña, Mónica
AU - Puertas, Javier
AU - Dalmases, Mireia
AU - Salord, Neus
AU - Corral, Jaime
AU - Jurado, Bernabé
AU - León, Carmen
AU - Egea, Carlos
AU - Muñoz, Aida
AU - Parra, Olga
AU - Cambrodi, Roser
AU - Martel-Escobar, María
AU - Arqué, Meritxell
AU - Montserrat, Josep M.
AU - López, Ester
AU - Gasa, Mercè
AU - García-Ledesma, Estefania
AU - Rosco-Due, Maria Isabel
AU - Durán, Joaquín
AU - Reyes-Nuñez, Nuria
AU - Pou, Susana
AU - Del Campo, Félix
AU - Sampol, Gabriel
AU - Romero, Odile
AU - Torres, Marta
PY - 2015/11/1
Y1 - 2015/11/1
N2 - Background: Compliance with continuous positive airway pressure (CPAP) therapy is essential in patients with obstructive sleep apnoea (OSA), but adequate control is not always possible. This is clinically important because CPAP can reverse the morbidity and mortality associated with OSA. Telemedicine, with support provided via a web platform and video conferences, could represent a cost-effective alternative to standard care management. Aim: To assess the telemedicine impact on treatment compliance, cost-effectiveness and improvement in quality of life (QoL) when compared with traditional face-to-face follow-up. Methods: A randomised controlled trial was performed to compare a telemedicine-based CPAP follow-up strategy with standard face-to-face management. Consecutive OSA patients requiring CPAP treatment, with sufficient internet skills and who agreed to participate, were enrolled. They were followed-up at 1, 3 and 6 months and answered surveys about sleep, CPAP side effects and lifestyle. We compared CPAP compliance, cost-effectiveness and QoL between the beginning and the end of the study. A Bayesian cost-effectiveness analysis with non-informative priors was performed. Results: We randomised 139 patients. At 6 months, we found similar levels of CPAP compliance, and improved daytime sleepiness, QoL, side effects and degree of satisfaction in both groups. Despite requiring more visits, the telemedicine group was more cost-effective: costs were lower and differences in effectiveness were not relevant. Conclusions: A telemedicine-based strategy for the follow-up of CPAP treatment in patients with OSA was as effective as standard hospital-based care in terms of CPAP compliance and symptom improvement, with comparable side effects and satisfaction rates. The telemedicine-based strategy had lower total costs due to savings on transport and less lost productivity (indirect costs).
AB - Background: Compliance with continuous positive airway pressure (CPAP) therapy is essential in patients with obstructive sleep apnoea (OSA), but adequate control is not always possible. This is clinically important because CPAP can reverse the morbidity and mortality associated with OSA. Telemedicine, with support provided via a web platform and video conferences, could represent a cost-effective alternative to standard care management. Aim: To assess the telemedicine impact on treatment compliance, cost-effectiveness and improvement in quality of life (QoL) when compared with traditional face-to-face follow-up. Methods: A randomised controlled trial was performed to compare a telemedicine-based CPAP follow-up strategy with standard face-to-face management. Consecutive OSA patients requiring CPAP treatment, with sufficient internet skills and who agreed to participate, were enrolled. They were followed-up at 1, 3 and 6 months and answered surveys about sleep, CPAP side effects and lifestyle. We compared CPAP compliance, cost-effectiveness and QoL between the beginning and the end of the study. A Bayesian cost-effectiveness analysis with non-informative priors was performed. Results: We randomised 139 patients. At 6 months, we found similar levels of CPAP compliance, and improved daytime sleepiness, QoL, side effects and degree of satisfaction in both groups. Despite requiring more visits, the telemedicine group was more cost-effective: costs were lower and differences in effectiveness were not relevant. Conclusions: A telemedicine-based strategy for the follow-up of CPAP treatment in patients with OSA was as effective as standard hospital-based care in terms of CPAP compliance and symptom improvement, with comparable side effects and satisfaction rates. The telemedicine-based strategy had lower total costs due to savings on transport and less lost productivity (indirect costs).
U2 - 10.1136/thoraxjnl-2015-207032
DO - 10.1136/thoraxjnl-2015-207032
M3 - Article
SN - 0040-6376
VL - 70
SP - 1054
EP - 1061
JO - Thorax
JF - Thorax
IS - 11
ER -