Pietzsch JB, Richter AK, Randerath W, Steffen A, Liu S, Geisler BP, Wasem J, Biermann-Stallwitz J. Clinical and economic benefits of upper airway stimulation for obstructive sleep apnea in a European setting. Respiration. 2019;98(1):38–47; doi: 10.1159/000497101.

Objectives. Upper airway stimulation (UAS) is a treatment approach for patients with moderate-to-severe obstructive sleep apnea who cannot adhere to continuous positive airway pressure therapy. Our objective was to evaluate added patient benefit and cost-effectiveness of UAS in the German healthcare system.

Methods. We employed a decision-analytic (Markov) model to project major adverse cardiovascular or cerebrovascular events (myocardial infarction or stroke), motor vehicle collision, mortality, quality-adjusted life years (QALYs), and costs. The assumed reduction in the apnea-hypopnea index with UAS compared to no treatment is based on German real-world data. Other input data were derived from the literature, public statistics, and multivariate regression. Cost-effectiveness was evaluated in euros per QALY gained, both discounted at 3%.

Results. UAS was projected to reduce the 10-year relative risks for stroke (0.76), myocardial infarction (0.64), cardiovascular death (0.65), and motor vehicle collision (0.34), and to increase survival by 1.27 years. While the UAS strategy added 1.02 QALYs within the patient lifetime, there were also additional costs of €45,196, resulting in an incremental cost-effectiveness ratio of €44,446 per QALY gained.

Conclusions. In the present model-based analysis, UAS therapy provides meaningful benefit to patient-relevant endpoints and is a cost-effective therapy in the German setting.