Cost effectiveness of obstructive sleep apnea therapies: a systematic review and meta-analysis of cost utility studies.

Objectives: Obstructive sleep apnea (OSA) is a sleep-related breathing disorder characterized by recurrent episodes of nocturnal breathing cessation resulting from upper airway collapse. Given the absence of a comprehensive review of the cost-effectiveness of OSA treatments, we undertook an extensive systematic review and meta-analysis to calculate the pooled incremental net benefit (INBp).

Methods: A systematic search of PubMed, Embase, Scopus, and Tufts cost-effectiveness analysis registry was conducted. INBp with 95% confidence intervals (CI) was estimated using a random-effects model, and heterogeneity was assessed through the Cochrane-Q test and I² statistic. Study quality was evaluated using the modified ECOBIAS Checklist, and GRADE framework was applied to assess the certainty of outcomes.

Results: Thirty-four studies were included in the systematic review, fifteen qualifying for meta-analysis. CPAP was cost-effective compared to other treatments, with a INBp of $13,024 (95%CI $6,813 to $19,236), and substantial heterogeneity (I² = 97.48%). Compared to no treatment and oral appliances (OAs), CPAP showed cost-effective INB values of $30,834 ($21,325 to $40,343) and $2,708 ($645 to $4,771) respectively.

Conclusion: CPAP is cost effective compared to all treatments collectively, as well as specifically to OAs and no treatment though with low certainty.