Background Obesity hypoventilation syndrome (OHS) is treated with either non-invasive ventilation (NIV) or CPAP, but there are no long-term cost-effectiveness studies comparing the two treatment modalities. Objectives We performed a large, multicentre, randomised, open-label controlled study to determine the comparative long-term cost and effectiveness of NIV versus CPAP in patients with OHS with severe obstructive sleep apnoea (OSA) using hospitalisation days as the primary outcome measure. Methods Hospital resource utilisation and within trial costs were evaluated against the difference in effectiveness based on the primary outcome (hospitalisation days/year, transformed and non-transformed in monetary term). Costs and effectiveness were estimated from a log-normal distribution using a Bayesian approach. A secondary analysis by adherence subgroups was performed. Results In total, 363 patients were selected, 215 were randomised and 202 were available for the analysis. The median (IQR) follow-up was 3.01 (2.91–3.14) years for NIV group and 3.00 (2.92–3.17) years for CPAP. The mean (SD) Bayesian estimated hospital days was 2.13 (0.73) for CPAP and 1.89 (0.78) for NIV. The mean (SD) Bayesian estimated cost per patient/year in the NIV arm, excluding hospitalisation costs, was €2075.98 (91.6), which was higher than the cost in the CPAP arm of €1219.06 (52.3); mean difference €857.6 (105.5). CPAP was more cost-effective than NIV (99.5% probability) because longer hospital stay in the CPAP arm was compensated for by its lower costs. Similar findings were observed in the high and low adherence subgroups. Conclusion CPAP is more cost-effective than NIV; therefore, CPAP should be the preferred treatment for patients with OHS with severe OSA. Trial registration number NCT01405976

中文翻译：

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气道正压通气方式治疗肥胖低通气综合征合并重度阻塞性睡眠呼吸暂停的成本效益

背景 肥胖低通气综合征 (OHS) 可通过无创通气 (NIV) 或 CPAP 进行治疗，但没有比较两种治疗方式的长期成本效益研究。目标 我们进行了一项大型、多中心、随机、开放标签对照研究，以确定 NIV 与 CPAP 对患有严重阻塞性睡眠呼吸暂停 (OSA) 的 OHS 患者的长期成本和有效性的比较，使用住院天数作为主要结果指标。方法 根据主要结局（住院天数/年，货币形式转换和未转换），针对有效性差异评估医院资源利用和试验内成本。使用贝叶斯方法从对数正态分布估计成本和有效性。依从性亚组进行了二次分析。结果 总共选择了 363 名患者，215 名随机化，202 名可用于分析。NIV 组的中位 (IQR) 随访时间为 3.01 (2.91-3.14) 年，CPAP 组为 3.00 (2.92-3.17) 年。CPAP 的平均 (SD) Bayesian 估计住院天数为 2.13 (0.73)，NIV 为 1.89 (0.78)。NIV 组每名患者/年的平均 (SD) 贝叶斯估计成本（不包括住院费用）为 2075.98 欧元（91.6），高于 CPAP 组的成本 1219.06 欧元（52.3）；平均差异 €857.6 (105.5)。CPAP 比 NIV 更具成本效益（概率为 99.5%），因为 CPAP 组的住院时间更长，成本更低。在高依从性和低依从性亚组中观察到类似的发现。结论 CPAP 比 NIV 更具成本效益；因此，CPAP 应该是 OHS 合并重度 OSA 患者的首选治疗方法。试验注册号 NCT01405976