Cost Savings from Treating Obstructive Sleep Apnoea: OHE Consulting Report

The British Lung Foundation commissioned OHE Consulting to undertake an analysis of the costs of obstructive sleep apnoea and the economic benefits of treating it. The results are summarised below.

Obstructive sleep apnoea (OSA) is the temporary cessation of breathing during sleep because of a narrowing or closure of the pharyngeal airway. It produces episodes of brief awakening from sleep as the body seeks to restore normal breathing. Although severity varies, untreated OSA can result in daytime sleepiness that affects cognitive function, mood and quality of life. Research has shown that this, in turn, can increase the risks of road traffic and work-related accidents, as well as cardiovascular disease and stroke from associated hypertension.

Currently, an estimated 1.8 million people in the UK are living with OSA, 1.5 million of them adults. Risk factors for developing it are gender (more likely in men), age (more likely in older people), diabetes, hypertension and obesity. These risk factors are expected to increase in prevalence, most likely producing a consequent increase in the costs of OSA as well.

Treatment for OSA varies with disease severity—mild, moderate or severe—and ranges from lifestyle changes and use of dental/oral devices to the use of continuous positive airway pressure (CPAP) machines. In 2008, NICE assessed three interventions and recommended the use of CPAP machines for adults with moderate or severe OAS, but recommend use in milder cases only if other options had failed or were inappropriate. NICE estimated the cost of treating OSA with CPAP at £5,000 per QALY, well below its ICER of £20,000–£30,000.

As the OHE Consulting report points out, other research has found that oral devices are preferred by some patients—particularly those with milder disease—and, while less cost-effective than CPAP machines, are cost effective compared to no treatment. Research on lifestyle changes, possibly appropriate for milder cases, is inconclusive at this point.

Despite the clear evidence of benefit, the report notes that recent research estimates that about 85% of OSA cases currently are undiagnosed and untreated in the UK. In this report, OHE Consulting calculates the direct savings that could be realised if more cases were treated. For example, increasing diagnosis and treatment rates from the current estimated 22% to 45% of people with OSA could yield annual savings of £28 million for the NHS and generate 20,000 additional QALYs; treating all people with moderate to severe OSA could produce an estimated £55 million in annual NHS savings and 40,000 QALYs compared to a situation where people with OSA are not treated or not diagnosed. The cost of not treating people with moderate-to-severe OSA, then, substantially exceeds that of treatment.

Indirect costs also could be reduced by treating a larger proportion of people with OSA. If all those estimated to have moderate to severe OSA in the UK were treated, approximately 40,000 road accidents could be prevented each year, reducing consequent injuries and fatalities. Work productivity also would likely increase and work-related injuries decrease.

An important complicating factor in increasing treatment rates is that the geographic distribution of people with OSA coincides poorly with the availability of diagnosis and treatment centers. For example, services are scarce in rural areas, where OSA is likely more prevalent as the population tends to be older than in urban areas. In addition to discouraging wider treatment, this mismatch undermines equity in access to care.

As the report notes in conclusion, much remains to be learned about OSA’s full range of causes and effects as well as the effectiveness, and cost effectiveness, of alternative interventions. A brief outline of needed research is included in the report.

For additional information, please contact Jon Sussex at OHE. For information about OHE Consulting and its services, please contact Jorge Mestre-Ferrandiz.

Download: Rejón-Parrilla, J.C., Garau, M. and Sussex, J., 2014. Obstructive sleep apnoea: health economics report. Consulting Report. London: Office of Health Economics.