Screening for obstructive sleep apnea in stroke patients: a cost-effectiveness analysis

Area of Science:

• Neurology
• Sleep Medicine
• Health Economics

Background:

• Obstructive sleep apnea (OSA) is prevalent in post-stroke patients and linked to poorer recovery.
• The impact of OSA screening and continuous positive airway pressure (CPAP) treatment on neurological outcomes remains unclear.

Purpose of the Study:

• To evaluate the cost-effectiveness of screening for OSA and subsequent CPAP treatment in patients following acute ischemic stroke.
• To determine the necessary treatment benefits for OSA screening and CPAP to be considered cost-effective.

Main Methods:

• A decision tree model compared two strategies: polysomnography (PSG) with 3-month CPAP for OSA patients versus no screening.
• The primary outcome measured was the quality-adjusted life year (QALY) gained, assessed against willingness-to-pay thresholds of $50,000 and $100,000 per QALY.

Main Results:

• The incremental cost-effectiveness ratio for OSA screening was $49,421 per QALY.
• Screening is cost-effective if CPAP improves patient utilities by over 0.2 for a $50,000/QALY threshold and 0.1 for a $100,000/QALY threshold.

Conclusions:

• From a cost-effectiveness perspective, a clinical trial is justified to investigate the efficacy of CPAP in improving stroke outcomes.
• Further research is needed to validate the benefits of OSA screening and CPAP treatment in stroke survivors.