Medicinsk teknologivurdering af obstruktiv ... - Danske Regioner

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Medicinsk teknologivurdering af obstruktiv ... - Danske Regioner

Medicinsk teknologivurdering af obstruktiv søvnapnø

Twenty-six public and private departments and clinics diagnosing and treating sleep

apnoea participated in a questionnaire study on diagnosis and treatment. All departments

and clinics use CRM for diagnosis and some use PSG in special cases. 91% report

that the patient always meets a doctor during diagnostic procedures. The majority of

the diagnostic procedures take place in the patients' own home. The primary treatment

for sleep apnoea is CPAP. All patients are offered follow-up consultations after treatment

has been initiated or completed.

Economy

On the basis of the studies included, there is limited evidence that CRM is a more costeffective

method than PSG concerning diagnosis of patients with OSA.

CPAP treatment is a cost-effective alternative to no treatment/conservative treatment

or treatment with oral appliances in patients with OSA (moderate evidence).

Oral appliances are a cost-effective treatment alternative to no treatment for patients

who do not accept or tolerate CPAP treatment (moderate evidence).

The complexity of the disease and the quality of the accessible Danish data have not

made it possible to make a health economic evaluation within the HTA framework. An

overview has been made of the immediate hospital costs of applied diagnostic methods.

Moreover, an overview has been made of costs related to treatment during one year

with CPAP and oral appliances, respectively.

Perspectives

There is no reliable data on the prevalence of OSA in the Danish population. Previous studies

have found that 4% of men and 2% of women have OSA. If this estimate is somewhat

reliable, the current number of treated patients indicates that a further growth is substantiated.

Whether the applied diagnostics and treatment are effective and cost-effective is a

central issue in the report. The reviewed studies show that this is most often the case.

The report also wishes to focus on the limitations in the lack of standardisation of the two

primary disease classification systems in relation to OSA – the American Academy of Sleep

Medicine classification system and the WHO Classification of Diseases (ICD). In addition a

harmonisation is missing in the use of methods and tools to measure and assess the severity

of OSA and the effect of treatment.

Need for research/development in the field

Among patients with OSA especially studies/steps to improve pre-diagnostics in the

primary sector should be initiated as well as studies on the development in quality of life

in this patient group.

Studies are missing on the long-term effects/side-effects of using oral appliances and

there is a need for initiatives/studies to increase the degree of compliance for CPAP

treatment.

National clinical guidelines should be made for decision-makers in connection with diagnostics,

treatment and follow-up in patients with OSA. It should be clear in the guidelines

if the recommended diagnostics and treatment is evidence-based and whether

this is based on the common practice.

Side 14

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