Cost-Utility Analysis of Continuous Positive Airway Pressure Therapy Compared With Usual Care for Obstructive Sleep Apnea in the Public Health System in Brazil

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Tipo de produção
article
Data de publicação
2024
DOI
Scopus
Web of Science
PubMed
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ISSN da Revista
Título do Volume
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ELSEVIER
Autores
PACHITO, Daniela V.
ECKELI, Alan L.
Citação
VALUE IN HEALTH REGIONAL ISSUES, v.40, p.81-88, 2024
Projetos de Pesquisa
Unidades Organizacionais
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Resumo
Objectives: This study aimed to conduct a cost-utility analysis of continuous positive airway pressure (CPAP) therapy compared with usual care as treatment of moderate to severe cases of obstructive sleep apnea (OSA) in Brazil, where decentralized policies of CPAP provision are in place.Methods: Markov cohort model comparing CPAP therapy with usual care, that is, no specific treatment for OSA, for moderate to severe cases was used. The payer perspective from the Unified Health System, Brazil, was adopted. Effectiveness parameters and costs related to health states were informed by literature review. Resource use related to CPAP therapy was defined by specialists and costs informed by recent purchase and leasing contracts. Incremental cost-effectiveness ratios were generated for purchase and leasing contracts to reflect current practices. A conservative willingness-to-pay threshold was set at 1 gross domestic product per capita per quality-adjusted life-year (QALY) (Brazilian reais [BRL] 40 712/QALY). Uncertainties were explored in deterministic and probabilistic sensitivity analyses.Results: Incremental cost-effectiveness ratio for the purchase modality was 8303 BRL/QALY and for leasing 45 192 BRL/QALY. Considering the adopted willingness-to-pay threshold, provision of CPAP by the purchase modality was considered costeffective but not the leasing modality. The parameter related to the greatest uncertainty was the reduction in the risk of having a stroke attributable to CPAP. Probabilistic analysis confirmed the robustness of results.Conclusions: CPAP therapy is a cost-effective alternative compared with usual care for moderate to severe OSA for the purchase modality. These results should help underpinning the decision making related to a uniform policy of CPAP provision across the country.
Palavras-chave
continuous positive airway pressure, cost-effectiveness analysis, obstructive, sleep apnea
URI
https://observatorio.fm.usp.br/handle/OPI/57876
Referências
  1. [Anonymous], Life expectancy in Brazil
  2. [Anonymous], International classification of sleep disorders, VThird
  3. [Anonymous], Secretaria de ciencia tecnologia e insumos estrategicos, V2nd
  4. Antonopoulos CN, 2011, SLEEP MED REV, V15, P301, DOI 10.1016/j.smrv.2010.10.002
  5. Arzt M, 2005, AM J RESP CRIT CARE, V172, P1447, DOI 10.1164/rccm.200505-702OC
  6. Ayas NT, 2006, ARCH INTERN MED, V166, P977, DOI 10.1001/archinte.166.9.977
  7. Baguet JP, 2012, NAT REV CARDIOL, V9, P679, DOI 10.1038/nrcardio.2012.141
  8. Bates BE, 2014, PM&R, V6, P473, DOI 10.1016/j.pmrj.2013.11.006
  9. Andrade SSCD, 2017, EPIDEMIOL SERV SAUDE, V26, P31, DOI [10.5123/S1679-49742017000100004, 10.5123/s1679-49742017000100004]
  10. Chen YP, 2020, LANCET GLOB HEALTH, V8, pE580
  11. Funcia FR, 2019, CIENC SAUDE COLETIVA, V24, P4405, DOI 10.1590/1413-812320182412.25892019
  12. Gay JG, 2018, VALUE HEALTH, V21, pS258, DOI 10.1016/j.jval.2018.09.1538
  13. Graham JD, 1997, JAMA-J AM MED ASSOC, V278, P1418, DOI 10.1001/jama.278.17.1418
  14. Hou HF, 2018, J GLOB HEALTH, V8, DOI 10.7189/jogh.08.010405
  15. Huber FL, 2021, RESPIRATION, V100, P328, DOI 10.1159/000513306
  16. Husereau D, 2022, BMC HEALTH SERV RES, V22, DOI [10.1186/s12913-021-07460-7, 10.18553/jmcp.2022.cheers]
  17. Javaheri S, 2020, AM J RESP CRIT CARE, V201, P607, DOI 10.1164/rccm.201908-1593LE
  18. Karimi M, 2015, SLEEP, V38, P341, DOI 10.5665/sleep.4486
  19. Léger D, 2020, SLEEP MED REV, V51, DOI 10.1016/j.smrv.2020.101275
  20. Loke YK, 2012, CIRC-CARDIOVASC QUAL, V5, P720, DOI 10.1161/CIRCOUTCOMES.111.964783
  21. Lucchetta RC, 2019, VALUE HEALTH, V22, pS217, DOI 10.1016/j.jval.2019.04.1007
  22. Marin JM, 2005, LANCET, V365, P1046, DOI 10.1016/S0140-6736(05)71141-7
  23. Mazzotti DR, 2019, AM J RESP CRIT CARE, V200, P493, DOI 10.1164/rccm.201808-1509OC
  24. McEvoy RD, 2016, NEW ENGL J MED, V375, P919, DOI 10.1056/NEJMoa1606599
  25. McMillan A, 2015, HEALTH TECHNOL ASSES, V19, P1, DOI 10.3310/hta19400
  26. Pachito DV, 2022, SLEEP BREATH, V26, P17, DOI 10.1007/s11325-021-02362-8
  27. Parati G, 2013, EUR RESPIR J, V41, P523, DOI 10.1183/09031936.00226711
  28. Patil SP, 2019, J CLIN SLEEP MED, V15, P335, DOI 10.5664/jcsm.7640
  29. Qie RR, 2020, J DIABETES, V12, P455, DOI 10.1111/1753-0407.13017
  30. Queiroz DLC, 2014, BRAZ J OTORHINOLAR, V80, P126, DOI 10.5935/1808-8694.20140027
  31. Reis M, 2018, J Bras Econ Saude, V10, P219
  32. Safanelli J, 2019, ARQ NEURO-PSIQUIAT, V77, P404, DOI [10.1590/0004-282X20190059, 10.1590/0004-282x20190059]
  33. Secretaria de ciencia tecnologia e insumos estrategicos em Saude, Departamento de gestao e incorporacao de tecnologias e inovacao em saude. O Uso de Limiares de Custo-Efetividade nas Decisoes em Saude: recomendacoes da Comissao Nacional de Incorporacao de Tecnologias no SUS
  34. Senaratna CV, 2017, SLEEP MED REV, V34, P70, DOI 10.1016/j.smrv.2016.07.002
  35. Trakada G, 2015, SLEEP BREATH, V19, P467, DOI 10.1007/s11325-014-1050-5
  36. TreeAge Software, TreeAge Pro 2022, R1
  37. Vorko-Jovic A, 2006, J SAFETY RES, V37, P93, DOI 10.1016/j.jsr.2005.08.009
  38. Whitehead SJ, 2010, BRIT MED BULL, V96, P5, DOI 10.1093/bmb/ldq033
  39. Wu SQ, 2012, BMC PUBLIC HEALTH, V12, DOI 10.1186/1471-2458-12-849
  40. Youssef Irini, 2018, J Sleep Disord Ther, V7, DOI 10.4172/2167-0277.1000282
  41. Zhang DW, 2021, FRONT PSYCHIATRY, V12, DOI 10.3389/fpsyt.2021.710435

Coleções
Artigos e Materiais de Revistas Científicas - FM/MCM
Artigos e Materiais de Revistas Científicas - HC/InCor
Artigos e Materiais de Revistas Científicas - LIM/63
Artigos e Materiais de Revistas Científicas - ODS/03