Exploring the Potential Cost-Effectiveness of Patient Decision Aids for Use in Adults with Obstructive Sleep Apnea: A Case Study

Med Decis Making. 2015 Jul;35(5):671-82. doi: 10.1177/0272989X14556676. Epub 2014 Oct 24.


Background: There is increasing evidence highlighting the effectiveness of patient decision aids (PtDAs), but evidence supporting their cost-effectiveness is lacking. We consider patients with obstructive sleep apnea (OSA), in whom a PtDA may decrease nonadherence to treatment by empowering patients to receive the option that is most congruent with their own values.

Objective: To determine the potential costs and benefits of delivering a PtDA to patients with moderate OSA.

Methods: A Markov cohort decision-analytic model was developed for patients with moderate OSA, comparing a PtDA to usual care over 5 years from a societal perspective. Data for patient preference for treatment options was taken from a recent randomized crossover trial, event data (cardiovascular, motor vehicle accidents) came from national databases and published literature. Potential improvements in adherence are unknown, so we considered a realistic range of values. Outcome measures were 5-year costs (in 2010 Canadian dollars), quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER).

Results: When adherence to treatment was unchanged, the PtDA strategy was dominated by incurring lower QALYs and higher costs. When nonadherence was decreased by 20% in the PtDA arm (corresponding to an increase in adherence from 63% to 70% for continuous positive airway pressure and from 77% to 82% for mandibular advancement splints in year 1), the ICER fell to $62,414/QALY. Costs associated with the treatment devices and delivering the PtDA had the greatest effect on cost-effectiveness.

Limitations: The model relies on surrogate measures and opinions for key parameters.

Conclusions: The cost-effectiveness of PtDAs will depend on contextual factors, but a framework is described for properly considering their long-term cost-effectiveness. A number of important questions around the appropriateness of benefit measurement for PtDA trials are highlighted.

Keywords: cost-effectiveness analysis; decision aids, patient decision making; economics.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Canada
  • Continuous Positive Airway Pressure / economics*
  • Cost-Benefit Analysis
  • Decision Support Techniques*
  • Humans
  • Markov Chains
  • Middle Aged
  • Patient Compliance
  • Quality-Adjusted Life Years
  • Randomized Controlled Trials as Topic
  • Sleep Apnea, Obstructive / economics*
  • Sleep Apnea, Obstructive / therapy

Grant support