Cost-Effectiveness of Obstructive Sleep Apnea Screening and Treatment Before Catheter Ablation for Symptomatic Atrial Fibrillation

Hiroshi Kawakami; Makoto Saito; Satoshi Kodera; Akira Fujii; Takayuki Nagai; Teruyoshi Uetani; Sakurako Tanno; Yasunori Oka; Shuntaro Ikeda; Issei Komuro; Thomas H. Marwick; Osamu Yamaguchi

doi:10.1253/circrep.CR-20-0074

Medical Economy

Cost-Effectiveness of Obstructive Sleep Apnea Screening and Treatment Before Catheter Ablation for Symptomatic Atrial Fibrillation

Hiroshi Kawakami, Makoto Saito, Satoshi Kodera, Akira Fujii, Takayuki Nagai, Teruyoshi Uetani, Sakurako Tanno, Yasunori Oka, Shuntaro Ikeda, Issei Komuro, Thomas H. Marwick, Osamu Yamaguchi

Author information

Hiroshi Kawakami
Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine [Japan]
Department of Cardiac Imaging, Baker Heart and Diabetes Institute [Australia]
School of Public Health and Preventative Medicine, Monash University [Australia]
Makoto Saito
Department of Cardiology, Kitaishikai Hospital [Japan]
Satoshi Kodera
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo [Japan]
Akira Fujii
Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine [Japan]
Takayuki Nagai
Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine [Japan]
Teruyoshi Uetani
Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine [Japan]
Center for Sleep Medicine, Ehime University Hospital [Japan]
Sakurako Tanno
Center for Sleep Medicine, Ehime University Hospital [Japan]
Yasunori Oka
Center for Sleep Medicine, Ehime University Hospital [Japan]
Shuntaro Ikeda
Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine [Japan]
Issei Komuro
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo [Japan]
Thomas H. Marwick
Department of Cardiac Imaging, Baker Heart and Diabetes Institute [Australia]
School of Public Health and Preventative Medicine, Monash University [Australia]
Osamu Yamaguchi
Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine [Japan]

Keywords: Atrial fibrillation, Catheter ablation, Continuous positive airway pressure ventilation, Cost-effectiveness, Obstructive sleep apnea

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Supplementary material

2020 Volume 2 Issue 9 Pages 507-516

DOI https://doi.org/10.1253/circrep.CR-20-0074

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Abstract

Background:Although management of obstructive sleep apnea (OSA) has been recommended to improve outcomes of catheter ablation (CA) in patients with symptomatic atrial fibrillation (AF), the most cost-effective way of preprocedural OSA screening is undetermined. This study assessed the cost-effectiveness of OSA management before CA for symptomatic AF.

Methods and Results:A Markov model was developed to assess the cost-effectiveness of 3 OSA detection strategies before CA: no screening; Type 3 portable monitor (PM)-guided screening; and polysomnography (PSG)-guided screening. The target population consisted of a hypothetical cohort of patients aged 65 years with symptomatic AF, with 50% prevalence of OSA. We used a 5-year horizon, with sensitivity analyses for significant variables and scenario analyses for lower and higher OSA prevalence (30% and 70%, respectively). In the base-case, both types of OSA screening were dominant (less costly and more effective) relative to no screening. Although PSG-guided management was more effective than PM-guided management, it was more costly and therefore did not show clear benefit. These findings were replicated in cohorts with lower and higher OSA risks.

Conclusions:OSA screening before CA is cost-effective in patients with symptomatic AF, with PM screening being the most cost-effective. Physicians should consider OSA management using this simple tool in the decision making for treatment of symptomatic AF.

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