QUALITY-ADJUSTED LIFE YEARS ADDED BY TREATMENT OF OBSTRUCTIVE SLEEP-APNEA

We assessed the impact of treatment with nasal continuous positive air way pressure (nCPAP) on the quality of life of 19 patients with obstru ctive sleep apnea (OSA). We measured the utility for the patients' hea lth states before and with treatment using the standard gamble approac h. The study group had an average age of 57 years and had been on trea tment for a mean of 9.5 months. For all the patients, the polysomnogra phic indicators of OSA disease severity improved markedly with treatme nt. For nine of the 12 symptoms most commonly associated with OSA, the patients reported improvement during treatment. The mean utility and the standard deviation obtained with the standard gamble method were 0 .87 +/- 0.17 on treatment and 0.63 +/- 0.29 pretreatment. The differen ce in utility between treatment and pretreatment health states was com bined with the life expectancy of each patient to generate the number of quality adjusted life years (QALYs) considered equivalent to the im pact of treatment. This resulted in an average gain of 5.4 QALYs. When we related this impact to the cost of treatment, we obtained a cost-u tility ratio between Can $3,397 and Can $9,792 per QALY added. These c osts are relatively small when compared to the cost per QALY for many other clinical interventions. Hence, nCPAP clearly offers the prospect for a well-tolerated therapy with a very favorable cost-utility ratio .