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Volume 15 No. 10
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Accepted Papers





Scientific Investigations

Clinical- and Cost-Effectiveness of a Mandibular Advancement Device Versus Continuous Positive Airway Pressure in Moderate Obstructive Sleep Apnea

Grietje E. de Vries, MS1,2; Aarnoud Hoekema, MD, PhD3,4,5,6; Karin M. Vermeulen, PhD7; Johannes Q.P.J. Claessen, MD, PhD8; Wouter Jacobs, MD, PhD9; Jan van der Maten, MS10; Johannes H. van der Hoeven, MD, PhD11; Boudewijn Stegenga, MD, PhD3,†; Huib A. M. Kerstjens, MD, PhD1,2; Peter J. Wijkstra, MD, PhD1,2,12
1Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, The Netherlands; 2Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, The Netherlands; 3Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, The Netherlands; 4Department of Oral Kinesiology, Academic Center for Dentistry Amsterdam, MOVE Research Institute Amsterdam, University of Amsterdam and VU University Amsterdam, The Netherlands; 5Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands; 6Department of Oral and Maxillofacial Surgery, Tjongerschans Hospital Heerenveen, The Netherlands; 7Department of Epidemiology, University of Groningen, University Medical Center Groningen, The Netherlands; 8Department of Ear Nose and Throat surgery, Martini Hospital Groningen, The Netherlands; 9Department of Pulmonary Diseases, Martini Hospital Groningen, The Netherlands; 10Department of Pulmonary Diseases, Medical Center Leeuwarden, The Netherlands; 11Department of Clinical Neurophysiology, University of Groningen, University Medical Center Groningen, The Netherlands; 12Center for Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, The Netherlands;  Deceased October 27, 2018

Study Objectives:

Limited evidence exists on the cost-effectiveness of mandibular advancement device (MAD) compared to continuous positive airway pressure (CPAP) therapy in moderate obstructive sleep apnea (OSA). Therefore, this study compares the clinical and cost-effectiveness of MAD therapy with CPAP therapy in moderate OSA.

Methods:

In a multicentre randomized controlled trial, patients with an apnea-hypopnea index (AHI) of 15 to 30 events/h were randomized to either MAD or CPAP. Incremental cost-effectiveness and cost-utility ratios (ICER/ICUR, in terms of AHI reduction and quality-adjusted life-years [QALYs, based on the EuroQol Five-Dimension Quality of Life questionnaire]) were calculated after 12 months, all from a societal perspective.

Results:

In the 85 randomized patients (n = 42 CPAP, n = 43 MAD), AHI reduction was significantly greater with CPAP (median reduction AHI 18.3 [14.8–22.6] events/h) than with MAD therapy (median reduction AHI 13.5 [8.5–18.4] events/h) after 12 months. Societal costs after 12 months were higher for MAD than for CPAP (mean difference €2.156). MAD was less cost-effective than CPAP after 12 months (ICER −€305 [−€3.003 to €1.572] per AHI point improvement). However, in terms of QALY, MAD performed better than CPAP after 12 months (€33.701 [−€191.106 to €562.271] per QALY gained).

Conclusions:

CPAP was more clinically effective (in terms of AHI reduction) and cost-effective than MAD. However, costs per QALY was better with MAD as compared to CPAP. Therefore, CPAP is the first-choice treatment option in moderate OSA and MAD may be a good alternative.

Clinical Trial Registration:

Registry: ClinicalTrials.gov; Identifier: NCT01588275.

Citation:

de Vries GE, Hoekema A, Vermeulen KM, Claessen J, JacobsW, van derMaten J, van der Hoeven JH, Stegenga B, Kerstjens HAM,Wijkstra PJ. Clinicaland cost-effectiveness of a mandibular advancement device versus continuous positive airway pressure in moderate obstructive sleep apnea. J Clin Sleep Med. 2019;15(10):1477-1485.


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