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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

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



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.


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


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).


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.


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


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.


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

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