Clinical- and cost-effectiveness of a mandibular advancement device versus continuous positive airway pressure in moderate obstructive sleep apnea

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 V2.156). MAD was less cost-effective than CPAP after 12 months (ICER −V305 [−V3.003 to V1.572] per AHI point improvement). However, in terms of QALY, MAD performed better than CPAP after 12 months (V33.701 [−V191.106 to V562.271] 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.