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Comprehensive management of obstructive sleep apnea by telemedicine: Clinical improvement and cost-effectiveness of a Virtual Sleep Unit. A randomized controlled trial

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Listed:
  • Vera M Lugo
  • Onintza Garmendia
  • Monique Suarez-Girón
  • Marta Torres
  • Francisco J Vázquez-Polo
  • Miguel A Negrín
  • Anabel Moraleda
  • Mariana Roman
  • Marta Puig
  • Concepcion Ruiz
  • Carlos Egea
  • Juan F Masa
  • Ramon Farré
  • Josep M Montserrat

Abstract

Introduction: Obstructive sleep apnea (OSA) is a prevalent disease associated with significant morbidity and high healthcare costs. Information and communication technology could offer cost-effective management options. Objectives: To evaluate an out-of-hospital Virtual Sleep Unit (VSU) based on telemedicine to manage all patients with suspected OSA, including those with and without continuous positive airway pressure (CPAP) therapy. Methods: This was an open randomized controlled trial. Patients with suspected OSA were randomized to hospital routine (HR) or VSU groups to compare the clinical improvement and cost-effectiveness in a non-inferiority analysis. Improvement was assessed by changes in the Quebec Sleep Questionnaire (QSQ), EuroQol (EQ-5D and EQ-VAS), and Epworth Sleepiness Scale (ESS). The follow-up was 3 months. Cost-effectiveness was assessed by a Bayesian analysis based on quality-adjusted life-years (QALYs). Results: The HR group (n: 92; 78% OSA, 57% CPAP) compared with the VSU group (n: 94; 83% OSA, 43% CPAP) showed: CPAP compliance was similar in both groups, the QSQ social interactions domain improved significantly more in the HR group whereas the EQ-VAS improved more in the VSU group. Total and OSA-related costs were lower in the VSU group than the HR. The Bayesian cost-effectiveness analysis showed that VSU was cost-effective for a wide range of willingness to pay for QALYs. Conclusions: The VSU offered a cost-effective means of improving QALYs than HR. However, the assessment of its clinical improvement was influenced by the choice of the questionnaire; hence, additional measurements of clinical improvement are needed. Our findings indicate that VSU could help with the management of many patients, irrespective of CPAP use.

Suggested Citation

  • Vera M Lugo & Onintza Garmendia & Monique Suarez-Girón & Marta Torres & Francisco J Vázquez-Polo & Miguel A Negrín & Anabel Moraleda & Mariana Roman & Marta Puig & Concepcion Ruiz & Carlos Egea & Juan, 2019. "Comprehensive management of obstructive sleep apnea by telemedicine: Clinical improvement and cost-effectiveness of a Virtual Sleep Unit. A randomized controlled trial," PLOS ONE, Public Library of Science, vol. 14(10), pages 1-15, October.
    • Handle: RePEc:plo:pone00:0224069
    DOI: 10.1371/journal.pone.0224069
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    References listed on IDEAS

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    1. Gerald Richardson & Andrea Manca, 2004. "Calculation of quality adjusted life years in the published literature: a review of methodology and transparency," Health Economics, John Wiley & Sons, Ltd., vol. 13(12), pages 1203-1210, December.
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