Author(s)
Caroline Casey, MD
Catherine Geller, MD
Patrick Scheffler, MD, FRCSC
Affiliation(s)
Northwell Health
Abstract:
Background: Tongue base obstruction is the most common cause of persistent obstructive sleep apnea after adenotonsillectomy in complex pediatric patients. Tongue base suspension (TBS) surgically addresses this site of obstruction and can significantly improve OSA in these patients. This study aims to perform a health economic evaluation of tongue base suspension in CPAP intolerant patients with persistent OSA via cost effectiveness analysis
Methods: Cost effectiveness was performed via Markov model over a 5 year time horizon with costing and utility data obtained from the literature. Total costs included costs related to preoperative work-up including sleep endoscopy, polysomnographies, the surgery and hospital stay, postoperative visit and polysomnography, as well as annual outpatient monitoring. Based on conflicting literature data, a decreased effectiveness of TBS over time (“drop off”) was modeled and set at 33% over two years for the base case. Deterministic sensitivity analysis were performed varying TBS effectiveness, AHI improvement in partial treatment responders, and discount rate.
Results: In the base case, TBS lead to a total 5-year cost and utility of $12,659.87 for 4.18 QALYs compared to conservative management with $767.74 for 3.96 QALYs. The incremental cost effectiveness ratio (ICER) of $52,214.7 /QALY. At the typical willingness-to-pay threshold of $50,000 / QALY , TBS became cost-effective at time horizon of 6 years post implant with an ICER of $45,371.84/QALY. Varying the drop off effect from 0% to 100% varied the ICER from $42,091.31 to $100,610.3 per QALY.
Discussion: TBS can be a cost effective treatment for persistent OSA in complex pediatric patients even over a relatively short time horizon. Long-term cost-effectiveness remains harder to assess due to a lack of studies on long-term efficacy of the procedure.