A bayesian cost-effectiveness analysis of a telemedicine-based strategy for the management of sleep apnea: A multicenter randomized controlled trial

Background: Compliance with CPAP therapy is essential in patients with OSA but an adequate control is not always possible. This is of clinical importance as CPAP reverses OSA morbidity and mortality. Alternative and more cost-effective approaches are needed. A telemedicine-based strategy could be of great interest. Methods: One hundred thirty nine patients were randomized in a controlled trial that was performed to compare a telemedicine-based strategy for CPAP follow-up (patients9 support based on a web platform support and videoconferences) with the standard face-to-face control. Main outcomes were CPAP compliance and cost-effectiveness (Bayesian analysis). Secondary outcomes: Quality of life (QoL), satisfaction and secondary effects questionaries. Results: At six months, similar levels of CPAP compliance, improvement in sleepiness, QoL, side effects and degree of satisfaction were found in both groups. Despite observing more extra visits, the telemedicine group was more cost-effective: costs were lower and difference in effectiveness was not relevant. Discussion: A telemedicine-based strategy for the follow-up of OSA patients under CPAP treatment proved to be as effective as the standard hospital-based care in terms of CPAP compliance and improvement. Cost-effectiveness analysis showed that the telemedicine-based strategy presented lower total costs due to savings on transport and indirect costs of productivity losses. Funding: Supported by SEPAR/FIS PI14/00416. Supported in part by grant ECO2013-47092 (MINECO, Spain).