• Emerson M Wickwire, Jennifer S Albrecht, Maxwell M Towe, Samuel A Abariga, Montserrat Diaz-Abad, Andrea G Shipper, Liesl M Cooper, Samson Z Assefa, Sarah E Tom, and Steven M Scharf.
• Department of Psychiatry, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland, Baltimore, MD; Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland, Baltimore, MD. Electronic address: ewickwire@som.umaryland.edu.
• Chest. 2019 May 1; 155 (5): 947-961.

ObjectiveTo review systematically the published literature regarding the impact of treatment for OSA on monetized health economic outcomes.MethodsCustomized structured searches were performed in PubMed, Embase (Embase.com), and the Cochrane Central Register of Controlled Trials (Wiley) databases. Reference lists of eligible studies were also analyzed. Titles and abstracts were examined, and articles were identified for full-text review. Studies that met inclusion criteria were evaluated in detail, and study characteristics were extracted using a standardized template. Quantitative characteristics of the studies were summarized, and a qualitative synthesis was performed.ResultsLiterature searches identified 2,017 nonredundant abstracts, and 196 full-text articles were selected for review. Seventeen studies met inclusion criteria and were included in the final synthesis. Seven studies included formal cost-effectiveness or cost-utility analyses. Ten studies employed cohort designs, and four studies employed randomized controlled trial or quasi-experimental designs. Positive airway pressure was the most common treatment modality, but oral appliances and surgical approaches were also included. The most common health economic outcomes were health-care use (HCU) and quality-adjusted life years (QALYs). Follow-ups ranged from 6 weeks to 5 years. Overall, 15 of 18 comparisons found that treatment of OSA resulted in a positive economic impact. Treatment adherence and OSA severity were positively associated with cost-effectiveness.ConclusionsAlthough study methodologies varied widely, evidence consistently suggested that treatment of OSA was associated with favorable economic outcomes, including QALYs, within accepted ranges of cost-effectiveness, reduced HCU, and reduced monetized costs.Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.

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