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Med Decis Making. 2015 Jul;35(5):671-82. doi: 10.1177/0272989X14556676. Epub 2014 Oct 24.

Exploring the Potential Cost-Effectiveness of Patient Decision Aids for Use in Adults with Obstructive Sleep Apnea: A Case Study.

Author information

1
School of Population and Public Health, University of British Columbia, Vancouver, Canada (LT,NB)
2
Center for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada (LT, MS, NA, NB)
3
Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (LT, NA, LL, CM, NB)
4
Ottawa Hospital Research Institute, Ottawa, Canada (LT, DS)
5
Faculty of Dentistry, University of British Columbia, Vancouver, Canada (FA)
6
Collaboration for Outcomes Research and Evaluations, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada (MS, LL, CM)
7
Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada (NA)School of Pharmacy, Memorial University, St. John's, Canada (CM)
8
School of Nursing, University of Ottawa, Ottawa, Canada (DS).

Abstract

BACKGROUND:

There is increasing evidence highlighting the effectiveness of patient decision aids (PtDAs), but evidence supporting their cost-effectiveness is lacking. We consider patients with obstructive sleep apnea (OSA), in whom a PtDA may decrease nonadherence to treatment by empowering patients to receive the option that is most congruent with their own values.

OBJECTIVE:

To determine the potential costs and benefits of delivering a PtDA to patients with moderate OSA.

METHODS:

A Markov cohort decision-analytic model was developed for patients with moderate OSA, comparing a PtDA to usual care over 5 years from a societal perspective. Data for patient preference for treatment options was taken from a recent randomized crossover trial, event data (cardiovascular, motor vehicle accidents) came from national databases and published literature. Potential improvements in adherence are unknown, so we considered a realistic range of values. Outcome measures were 5-year costs (in 2010 Canadian dollars), quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER).

RESULTS:

When adherence to treatment was unchanged, the PtDA strategy was dominated by incurring lower QALYs and higher costs. When nonadherence was decreased by 20% in the PtDA arm (corresponding to an increase in adherence from 63% to 70% for continuous positive airway pressure and from 77% to 82% for mandibular advancement splints in year 1), the ICER fell to $62,414/QALY. Costs associated with the treatment devices and delivering the PtDA had the greatest effect on cost-effectiveness.

LIMITATIONS:

The model relies on surrogate measures and opinions for key parameters.

CONCLUSIONS:

The cost-effectiveness of PtDAs will depend on contextual factors, but a framework is described for properly considering their long-term cost-effectiveness. A number of important questions around the appropriateness of benefit measurement for PtDA trials are highlighted.

KEYWORDS:

cost-effectiveness analysis; decision aids, patient decision making; economics

PMID:
25344130
DOI:
10.1177/0272989X14556676
[Indexed for MEDLINE]

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