Economic evaluation of telemonitoring as a follow‐up approach for patients with obstructive sleep apnea syndrome starting treatment with continuous positive airway pressure

Abstract

SummaryTelemonitoring of obstructive sleep apnea patients is increasingly being adopted though its cost‐effectiveness evidence base is scanty. This study investigated whether telemonitoring is a cost‐effective strategy compared with the standard follow‐up in patients with obstructive sleep apnea who are starting continuous positive airway pressure treatment. In total, 167 obstructive sleep apnea patients were randomised into telemonitoring (n = 79) or standard follow‐up (n = 88), initiated continuous positive airway pressure treatment, and were followed up for 6 months. The frequencies of healthcare contacts, related costs (in USD 2021 prices), treatment effect and compliance were compared between the follow‐up approaches using generalised linear models. The cost effectiveness analysis was conducted from a healthcare perspective and the results presented as cost per avoided extra clinic visit. Additionally, patient satisfaction between the two approaches was explored. The analysis showed no baseline differences. At follow‐up, there was no significant difference in treatment compliance, and the mean residual apnea–hypoapnea index. There was no difference in total visits, adjusted incidence rate ratio 0.87 (0.72–1.06). Participants in the telemonitoring arm made eight times more telephone visits, 8.10 (5.04–13.84), and about 73% fewer physical healthcare visits 0.27 (0.20–0.36). This translated into significantly lower total costs for the telemonitoring approach compared with standard follow‐up, −192 USD (−346 to −41). The form of follow‐up seemed to have no impact on the extent of patient satisfaction. These results demonstrate the telemonitoring of patients with obstructive sleep apnea initiating continuous positive airway pressure treatment as a cost saving strategy and can be argued as a potential worthy investment.