Cost-effectiveness of CPAP treatment in a tax-funded healthcare system - a scoping review and suggestions for cost reduction of CPAP treatment.

Aims: Obstructive sleep apnoea (OSA) is an increasing global public health problem. The primary treatment option is continuous positive airway pressure (CPAP). The cost-effectiveness of CPAP in patients with OSA is incompletely characterized.

Methods: For this scoping review, we conducted a PubMed search for cost-effectiveness analysis of CPAP treatment in European countries with tax-funded healthcare systems and for clinical practices to reduce costs of CPAP without reducing treatment quality. OSA severity was classified by the overnight apnoea-hypopnea index (AHI). The primary outcome was to define the cost-effectiveness of CPAP in high-income European countries with tax-funded healthcare systems. The second outcome was to describe possible clinical practices that may reduce costs of CPAP for patients with OSA without reducing CPAP treatment quality.

Results: CPAP is a cost-effective treatment for those with severe or moderate OSA with symptoms, especially for middle-aged and overweight males. However, the cost-effectiveness remains unclear in mild OSA or moderate OSA without disabling sleepiness. Although CPAP adherence affects cost-effectiveness, this was not considered in all cost-effectiveness studies. The cost of CPAP treatment can be reduced, for instance, by choosing overnight polygraphy at home for diagnostics, remote contacts, nurse- and primary care-led follow-up, and by evaluating the number of necessary healthcare contacts for CPAP.

Conclusion: CPAP seems to be cost-effective and should be initiated at least for those with severe OSA or moderate OSA with symptoms. CPAP adherence should be considered in cost-effectiveness studies. There are clinical practices that can reduce CPAP treatment costs without reducing treatment quality.