ArticleJournal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine2015
A Cost-Effectiveness Analysis of Surgery for Middle-Aged Men with Severe Obstructive Sleep Apnea Intolerant of CPAP.
Article in Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
11 citing papers in PubMed, 2 syntheses or guidelines pooled it, 31 citations in OpenAlex.
- Impacts of conservative treatment on the clinical manifestations of obstructive sleep apnea-systematic review and meta-analysis.Sleep & breathing = Schlaf & Atmung · 2024Pooled it
- Content Comparison of Quality-of-Life Instruments Used in Economic Evaluations of Sleep Disorder Interventions: A Systematic Review.PharmacoEconomics · 2024Pooled it
- Redefining Obstructive Sleep Apnea: Treatment in the Modern Era.Pathophysiology : the official journal of the International Society for Pathophysiology · 2026Review
- Maxillomandibular advancement for obstructive sleep apnea: a contemporary review.Frontiers in surgery · 2026Review
- The long-term impact of expansion sphincter pharyngoplasty treatment on blood pressure control and health-related quality of life in patients with obstructive sleep apnea and hypertension.Sleep & breathing = Schlaf & Atmung · 2021Article
- Characterization of Sleep Architecture in Down Syndrome Patients Pre and Post Airway Surgery.Cureus · 2017Article
- When continuous positive airway pressure (CPAP) fails.Journal of thoracic disease · 2016Review
- Decision Modeling in Sleep Apnea: The Critical Roles of Pretest Probability, Cost of Untreated Obstructive Sleep Apnea, and Time Horizon.Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine · 2016Article
- A novel implantable device for the treatment of obstructive sleep apnea: clinical safety and feasibility.Nature and science of sleep · 2016Article
- Does surgery for obstructive sleep apnea provide value?Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine · 2015Article
- Zetapalatopharyngoplasty in treatment of obstructive sleep apnea: a 10-year retrospective study.Brazilian journal of otorhinolaryngologyArticle
Corrections and comments
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Authors and funding
4 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
STUDY
objectivesObstructive sleep apnea (OSA) is associated with increased cardiovascular morbidity and mortality. Conventional OSA therapy necessitates indefinite continuous positive airway pressure (CPAP). Although CPAP is an effective treatment modality, up to 50% of OSA patients are intolerant of CPAP. We explore whether surgical modalities developed for those intolerant of CPAP are cost-effective.
methodsWe construct a lifetime semi-Markov model of OSA that accounts for observed increased risks of stroke, cardiovascular disease, and motor vehicle collisions for a 50-year-old male with untreated severe OSA. Using this model, we compare the cost-effectiveness of (1) no treatment, (2) CPAP only, and (3) CPAP followed by surgery (either palatopharyngeal reconstructive surgery [PPRS] or multilevel surgery [MLS]) for those intolerant to CPAP.
resultsCompared with the CPAP only strategy, CPAP followed by PPRS (CPAP-PPRS) adds 0.265 quality adjusted life years (QALYs) for an increase of $2,767 (discounted 2010 dollars) and is highly cost effective with an incremental cost-effectiveness ratio (ICER) of $10,421/QALY for a 50-year-old male with severe OSA. Compared to a CPAP-PPRS strategy, the CPAP-MLS strategy adds 0.07 QALYs at an increase of $6,213 for an ICER of $84,199/QALY. The CPAP-PPRS strategy appears cost-effective over a wide range of parameter estimates.
conclusionsPalatopharyngeal reconstructive surgery appears cost-effective in middle-aged men with severe OSA intolerant of CPAP. Further research is warranted to better define surgical candidacy as well as short-term and long-term surgical outcomes. COMMENTARY: A commentary on this article appears in this issue on page 509.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.