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A Bayesian cost-effectiveness analysis of a telemedicine-based strategy for the management of sleep apnoea: a multicentre randomised controlled trial

2015; BMJ; Volume: 70; Issue: 11 Linguagem: Inglês

10.1136/thoraxjnl-2015-207032

1468-3296

Valentina Isetta, Miguel A. Negrín, Carmen Monasterio, Juan F. Masa, Nuria Feu, Ainhoa Álvarez Ruiz De Larrínaga, Francisco Campos‐Rodríguez, Concepción Ruı́z, Jorge Abad, Francisco José Vázquez Polo, Ramón Farré, Marina Galdeano, Patrícia Lloberes, Cristina Embid, Mónica de la Peña, Francisco Javier Puertas, Mireia Dalmases, Neus Salord, Jaime Corral, Bernabé Jurado Gámez, Carmen Martín de León, Carlos Egea, Aída Selfa Muñoz, Olga Parra, Roser Cambrodí, María del Carmen Martel Escobar, Meritxell Arqué, Josep M. Montserrat,

Neuroscience of respiration and sleep

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). Trial register number NCT01716676.