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Title: Long-term positive airway pressure therapy in obesity hypoventilation syndrome. Cost study
Authors: Sanchez Quiroga, Mª Ángeles
Masa Jiménez, Juan Fernando
Mokhlesi, Babak
Benitez, Ivan
Gómez De Terreros, Francisco Javier
Romero, Auxiliadora
Caballero Eraso, Candela
Teran Santos, Joaquin
Alonso Álvarez, María Luz
Troncoso, Maria Fernanda
González, Monica
López Martin, Soledad
Marín, José María
Marti, Sergi
Díaz Cambriles, Trinidad
Chiner, Eusebi
Egea Santaolalla, Carlos
Barca, Javier
Vázquez Polo, Francisco José 
Negrín Hernández, Miguel Ángel 
Martel Escobar, María Carmen 
Barbe, Ferran
Corral, Jaime
UNESCO Clasification: 320508 Enfermedades pulmonares
Keywords: Apnoea
RCT (Randomized Controlled Trial)
Issue Date: 2019
Journal: European Respiratory Journal 
Abstract: Rationale: Obesity hypoventilation syndrome (OHS) is commonly treated with noninvasive ventilation (NIV) or CPAP. NIV is more complex and costly but provides ventilatory support. To date there have been no long-term or cost trials comparing these treatment modalities. Methods: We performed a large, randomized, multicenter, open-label controlled trial in Spain to compare the long-term effectiveness of NIV and CPAP using hospitalization days/year-patient as the primary end point. We carried out a simple cost analysis including effectiveness cost during 3 year of follow-up. We included the following cost groups: visits, adjustment of NIV, tests, medication, therapies and hospital resources utilization. A sensitivity analysis was conducted according to 3 different scenarios guided by the International Gross Domestic Product. Results: In total, 215 patients with untreated OHS and severe obstructive sleep apnea (OSA) were randomized to NIV or CPAP therapy and followed at least 3 years. The effectiveness was close between arms (mean difference NIV-CPAP: -0.19, 95% CI -1.13 to 0.75). The cost per patient/year was lower in the CPAP arm (1,898.2€; SD 1939.5) than the cost in the NIV arm (2,809.3€; SD 2901.6), mean difference -911.1€ (p <0.0001). The sensitivity analysis showed a minimum mean savings per patient/year with CPAP of -553.4€ (p <0.0001) and a maximum of -1,619.5€ (p<0.0001). Conclusions: In stable patients with OHS and severe OSA, despite NIV having a slight advantage in effectiveness, CPAP could be considered the first line of treatment due to its lower cost but, a case-by-case assessment is recommended to detect patients who would benefit from a switch to NIV.
ISSN: 0903-1936
DOI: 10.1183/13993003.congress-2019.PA2013
Source: European Respiratory Journal [ISSN 0903-1936], v. 54 (63), PA2013
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