Comprehensive management of obstructive sleep apnea by telemedicine: Clinical improvement and cost-effectiveness of a Virtual Sleep Unit. A randomized controlled trial
Obstructive sleep apnea (OSA) is a prevalent disease associated with significant morbidity and high healthcare costs. Information and communication technology could offer cost-effective management options. To evaluate an out-of-hospital Virtual Sleep Unit (VSU) based on telemedicine to manage all pa...
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| Veröffentlicht in: | PloS one 2019-10, Vol.14 (10), p.e0224069-e0224069 |
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| creator | Lugo, Vera M Garmendia, Onintza Suarez-Girón, Monique Torres, Marta Vázquez-Polo, Francisco J Negrín, Miguel A Moraleda, Anabel Roman, Mariana Puig, Marta Ruiz, Concepcion Egea, Carlos Masa, Juan F Farré, Ramon Montserrat, Josep M |
| description | Obstructive sleep apnea (OSA) is a prevalent disease associated with significant morbidity and high healthcare costs. Information and communication technology could offer cost-effective management options.
To evaluate an out-of-hospital Virtual Sleep Unit (VSU) based on telemedicine to manage all patients with suspected OSA, including those with and without continuous positive airway pressure (CPAP) therapy.
This was an open randomized controlled trial. Patients with suspected OSA were randomized to hospital routine (HR) or VSU groups to compare the clinical improvement and cost-effectiveness in a non-inferiority analysis. Improvement was assessed by changes in the Quebec Sleep Questionnaire (QSQ), EuroQol (EQ-5D and EQ-VAS), and Epworth Sleepiness Scale (ESS). The follow-up was 3 months. Cost-effectiveness was assessed by a Bayesian analysis based on quality-adjusted life-years (QALYs).
The HR group (n: 92; 78% OSA, 57% CPAP) compared with the VSU group (n: 94; 83% OSA, 43% CPAP) showed: CPAP compliance was similar in both groups, the QSQ social interactions domain improved significantly more in the HR group whereas the EQ-VAS improved more in the VSU group. Total and OSA-related costs were lower in the VSU group than the HR. The Bayesian cost-effectiveness analysis showed that VSU was cost-effective for a wide range of willingness to pay for QALYs.
The VSU offered a cost-effective means of improving QALYs than HR. However, the assessment of its clinical improvement was influenced by the choice of the questionnaire; hence, additional measurements of clinical improvement are needed. Our findings indicate that VSU could help with the management of many patients, irrespective of CPAP use. |
| doi_str_mv | 10.1371/journal.pone.0224069 |
| format | Article |
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To evaluate an out-of-hospital Virtual Sleep Unit (VSU) based on telemedicine to manage all patients with suspected OSA, including those with and without continuous positive airway pressure (CPAP) therapy.
This was an open randomized controlled trial. Patients with suspected OSA were randomized to hospital routine (HR) or VSU groups to compare the clinical improvement and cost-effectiveness in a non-inferiority analysis. Improvement was assessed by changes in the Quebec Sleep Questionnaire (QSQ), EuroQol (EQ-5D and EQ-VAS), and Epworth Sleepiness Scale (ESS). The follow-up was 3 months. Cost-effectiveness was assessed by a Bayesian analysis based on quality-adjusted life-years (QALYs).
The HR group (n: 92; 78% OSA, 57% CPAP) compared with the VSU group (n: 94; 83% OSA, 43% CPAP) showed: CPAP compliance was similar in both groups, the QSQ social interactions domain improved significantly more in the HR group whereas the EQ-VAS improved more in the VSU group. Total and OSA-related costs were lower in the VSU group than the HR. The Bayesian cost-effectiveness analysis showed that VSU was cost-effective for a wide range of willingness to pay for QALYs.
The VSU offered a cost-effective means of improving QALYs than HR. However, the assessment of its clinical improvement was influenced by the choice of the questionnaire; hence, additional measurements of clinical improvement are needed. Our findings indicate that VSU could help with the management of many patients, irrespective of CPAP use.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0224069</identifier><identifier>PMID: 31647838</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Analysis ; Apnea ; Bayes Theorem ; Bayesian analysis ; Bioengineering ; Biology and Life Sciences ; Biophysics ; Cardiovascular diseases ; Care and treatment ; Clinical trials ; Continuous positive airway pressure ; Continuous Positive Airway Pressure - methods ; Cost analysis ; Cost benefit analysis ; Disease control ; Disease Management ; Female ; Health care costs ; Health sciences ; Hospitals ; Humans ; Male ; Management ; Medical diagnosis ; Medical economics ; Medicine ; Medicine and Health Sciences ; Methods ; Middle Aged ; Morbidity ; Patient compliance ; Patient Compliance - statistics & numerical data ; Patient satisfaction ; Patients ; People and places ; Quality of Life ; Questionnaires ; Randomization ; Research and Analysis Methods ; Risk factors ; Sleep ; Sleep and wakefulness ; Sleep apnea ; Sleep Apnea, Obstructive - economics ; Sleep Apnea, Obstructive - therapy ; Sleep disorders ; Sleepiness ; Social behavior ; Social factors ; Social interactions ; Social Sciences ; Studies ; Surveys and Questionnaires ; Technology ; Telemedicine ; Telemedicine - methods</subject><ispartof>PloS one, 2019-10, Vol.14 (10), p.e0224069-e0224069</ispartof><rights>COPYRIGHT 2019 Public Library of Science</rights><rights>2019 Lugo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2019 Lugo et al 2019 Lugo et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-b8adc78fe04c0279c2874d8669ecb5abe51322e6ea995062d67f95c28c68f7013</citedby><cites>FETCH-LOGICAL-c692t-b8adc78fe04c0279c2874d8669ecb5abe51322e6ea995062d67f95c28c68f7013</cites><orcidid>0000-0003-3098-4605 ; 0000-0002-0632-6138</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6812794/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6812794/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31647838$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Penzel, Thomas</contributor><creatorcontrib>Lugo, Vera M</creatorcontrib><creatorcontrib>Garmendia, Onintza</creatorcontrib><creatorcontrib>Suarez-Girón, Monique</creatorcontrib><creatorcontrib>Torres, Marta</creatorcontrib><creatorcontrib>Vázquez-Polo, Francisco J</creatorcontrib><creatorcontrib>Negrín, Miguel A</creatorcontrib><creatorcontrib>Moraleda, Anabel</creatorcontrib><creatorcontrib>Roman, Mariana</creatorcontrib><creatorcontrib>Puig, Marta</creatorcontrib><creatorcontrib>Ruiz, Concepcion</creatorcontrib><creatorcontrib>Egea, Carlos</creatorcontrib><creatorcontrib>Masa, Juan F</creatorcontrib><creatorcontrib>Farré, Ramon</creatorcontrib><creatorcontrib>Montserrat, Josep M</creatorcontrib><title>Comprehensive management of obstructive sleep apnea by telemedicine: Clinical improvement and cost-effectiveness of a Virtual Sleep Unit. A randomized controlled trial</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Obstructive sleep apnea (OSA) is a prevalent disease associated with significant morbidity and high healthcare costs. Information and communication technology could offer cost-effective management options.
To evaluate an out-of-hospital Virtual Sleep Unit (VSU) based on telemedicine to manage all patients with suspected OSA, including those with and without continuous positive airway pressure (CPAP) therapy.
This was an open randomized controlled trial. Patients with suspected OSA were randomized to hospital routine (HR) or VSU groups to compare the clinical improvement and cost-effectiveness in a non-inferiority analysis. Improvement was assessed by changes in the Quebec Sleep Questionnaire (QSQ), EuroQol (EQ-5D and EQ-VAS), and Epworth Sleepiness Scale (ESS). The follow-up was 3 months. Cost-effectiveness was assessed by a Bayesian analysis based on quality-adjusted life-years (QALYs).
The HR group (n: 92; 78% OSA, 57% CPAP) compared with the VSU group (n: 94; 83% OSA, 43% CPAP) showed: CPAP compliance was similar in both groups, the QSQ social interactions domain improved significantly more in the HR group whereas the EQ-VAS improved more in the VSU group. Total and OSA-related costs were lower in the VSU group than the HR. The Bayesian cost-effectiveness analysis showed that VSU was cost-effective for a wide range of willingness to pay for QALYs.
The VSU offered a cost-effective means of improving QALYs than HR. However, the assessment of its clinical improvement was influenced by the choice of the questionnaire; hence, additional measurements of clinical improvement are needed. Our findings indicate that VSU could help with the management of many patients, irrespective of CPAP use.</description><subject>Analysis</subject><subject>Apnea</subject><subject>Bayes Theorem</subject><subject>Bayesian analysis</subject><subject>Bioengineering</subject><subject>Biology and Life Sciences</subject><subject>Biophysics</subject><subject>Cardiovascular diseases</subject><subject>Care and treatment</subject><subject>Clinical trials</subject><subject>Continuous positive airway pressure</subject><subject>Continuous Positive Airway Pressure - methods</subject><subject>Cost analysis</subject><subject>Cost benefit analysis</subject><subject>Disease control</subject><subject>Disease Management</subject><subject>Female</subject><subject>Health care costs</subject><subject>Health sciences</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Male</subject><subject>Management</subject><subject>Medical diagnosis</subject><subject>Medical economics</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Methods</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Patient compliance</subject><subject>Patient Compliance - statistics & numerical data</subject><subject>Patient satisfaction</subject><subject>Patients</subject><subject>People and places</subject><subject>Quality of Life</subject><subject>Questionnaires</subject><subject>Randomization</subject><subject>Research and Analysis Methods</subject><subject>Risk factors</subject><subject>Sleep</subject><subject>Sleep and wakefulness</subject><subject>Sleep apnea</subject><subject>Sleep Apnea, Obstructive - economics</subject><subject>Sleep Apnea, Obstructive - therapy</subject><subject>Sleep disorders</subject><subject>Sleepiness</subject><subject>Social behavior</subject><subject>Social factors</subject><subject>Social interactions</subject><subject>Social Sciences</subject><subject>Studies</subject><subject>Surveys and Questionnaires</subject><subject>Technology</subject><subject>Telemedicine</subject><subject>Telemedicine - methods</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNk8-O0zAQxiMEYpfCGyCIhITg0GI7iRNzQKoq_lRaaSWW3avlOJPWlWMX26lYXojXxGmzqxbtAeVgy_5933hmMknyEqMZzkr8YWN7Z4Seba2BGSIkR5Q9Ss4xy8iUEpQ9PtqfJc-83yBUZBWlT5OzDNO8rLLqPPmzsN3WwRqMVztIO2HECjowIbVtamsfXC_DcOM1wDYVWwMirW_TADpijZLKwMd0oZVRUuhURTO7OxgI06TS-jCFtoW9iQHvB1-R3igX-shf7V2vjQqzdJ66KLGd-g2D0ARntY7b4JTQz5MnrdAeXozrJLn-8vnH4tv04vLrcjG_mErKSJjWlWhkWbWAcolIySSpyryJSTOQdSFqKHBGCFAQjBWIkoaWLSsiJWnVlghnk-T1wXerredjjT0nGaoow4zmkVgeiMaKDd861Ql3y61QfH9g3YoLF5TUwDPUYllKUhQg85zhqhYl5LlsMZOiqGn0-jRG6-tYTRnL5oQ-MT29MWrNV3bHaYVjdsNj3o0Gzv7swQfeKS9Ba2HA9vt3syEwGWK9-Qd9OLuRWomYgDKtjXHlYMrnFGUlKsv4F02S2QNU_BroVGwdtCqenwjenwiG9sKvsBK993x59f3_2cubU_btEbsGocPaW90HZY0_BfMDKJ313kF7X2SM-DBPd9XgwzzxcZ6i7NVxg-5FdwOU_QUTeR4W</recordid><startdate>20191024</startdate><enddate>20191024</enddate><creator>Lugo, Vera M</creator><creator>Garmendia, Onintza</creator><creator>Suarez-Girón, Monique</creator><creator>Torres, Marta</creator><creator>Vázquez-Polo, Francisco J</creator><creator>Negrín, Miguel A</creator><creator>Moraleda, Anabel</creator><creator>Roman, Mariana</creator><creator>Puig, Marta</creator><creator>Ruiz, Concepcion</creator><creator>Egea, Carlos</creator><creator>Masa, Juan F</creator><creator>Farré, Ramon</creator><creator>Montserrat, Josep M</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0003-3098-4605</orcidid><orcidid>https://orcid.org/0000-0002-0632-6138</orcidid></search><sort><creationdate>20191024</creationdate><title>Comprehensive management of obstructive sleep apnea by telemedicine: Clinical improvement and cost-effectiveness of a Virtual Sleep Unit. A randomized controlled trial</title><author>Lugo, Vera M ; Garmendia, Onintza ; Suarez-Girón, Monique ; Torres, Marta ; Vázquez-Polo, Francisco J ; Negrín, Miguel A ; Moraleda, Anabel ; Roman, Mariana ; Puig, Marta ; Ruiz, Concepcion ; Egea, Carlos ; Masa, Juan F ; Farré, Ramon ; Montserrat, Josep M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-b8adc78fe04c0279c2874d8669ecb5abe51322e6ea995062d67f95c28c68f7013</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Analysis</topic><topic>Apnea</topic><topic>Bayes Theorem</topic><topic>Bayesian analysis</topic><topic>Bioengineering</topic><topic>Biology and Life Sciences</topic><topic>Biophysics</topic><topic>Cardiovascular diseases</topic><topic>Care and treatment</topic><topic>Clinical trials</topic><topic>Continuous positive airway pressure</topic><topic>Continuous Positive Airway Pressure - methods</topic><topic>Cost analysis</topic><topic>Cost benefit analysis</topic><topic>Disease control</topic><topic>Disease Management</topic><topic>Female</topic><topic>Health care costs</topic><topic>Health sciences</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Male</topic><topic>Management</topic><topic>Medical diagnosis</topic><topic>Medical economics</topic><topic>Medicine</topic><topic>Medicine and Health Sciences</topic><topic>Methods</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Patient compliance</topic><topic>Patient Compliance - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lugo, Vera M</au><au>Garmendia, Onintza</au><au>Suarez-Girón, Monique</au><au>Torres, Marta</au><au>Vázquez-Polo, Francisco J</au><au>Negrín, Miguel A</au><au>Moraleda, Anabel</au><au>Roman, Mariana</au><au>Puig, Marta</au><au>Ruiz, Concepcion</au><au>Egea, Carlos</au><au>Masa, Juan F</au><au>Farré, Ramon</au><au>Montserrat, Josep M</au><au>Penzel, Thomas</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comprehensive management of obstructive sleep apnea by telemedicine: Clinical improvement and cost-effectiveness of a Virtual Sleep Unit. A randomized controlled trial</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2019-10-24</date><risdate>2019</risdate><volume>14</volume><issue>10</issue><spage>e0224069</spage><epage>e0224069</epage><pages>e0224069-e0224069</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Obstructive sleep apnea (OSA) is a prevalent disease associated with significant morbidity and high healthcare costs. Information and communication technology could offer cost-effective management options.
To evaluate an out-of-hospital Virtual Sleep Unit (VSU) based on telemedicine to manage all patients with suspected OSA, including those with and without continuous positive airway pressure (CPAP) therapy.
This was an open randomized controlled trial. Patients with suspected OSA were randomized to hospital routine (HR) or VSU groups to compare the clinical improvement and cost-effectiveness in a non-inferiority analysis. Improvement was assessed by changes in the Quebec Sleep Questionnaire (QSQ), EuroQol (EQ-5D and EQ-VAS), and Epworth Sleepiness Scale (ESS). The follow-up was 3 months. Cost-effectiveness was assessed by a Bayesian analysis based on quality-adjusted life-years (QALYs).
The HR group (n: 92; 78% OSA, 57% CPAP) compared with the VSU group (n: 94; 83% OSA, 43% CPAP) showed: CPAP compliance was similar in both groups, the QSQ social interactions domain improved significantly more in the HR group whereas the EQ-VAS improved more in the VSU group. Total and OSA-related costs were lower in the VSU group than the HR. The Bayesian cost-effectiveness analysis showed that VSU was cost-effective for a wide range of willingness to pay for QALYs.
The VSU offered a cost-effective means of improving QALYs than HR. However, the assessment of its clinical improvement was influenced by the choice of the questionnaire; hence, additional measurements of clinical improvement are needed. Our findings indicate that VSU could help with the management of many patients, irrespective of CPAP use.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>31647838</pmid><doi>10.1371/journal.pone.0224069</doi><tpages>e0224069</tpages><orcidid>https://orcid.org/0000-0003-3098-4605</orcidid><orcidid>https://orcid.org/0000-0002-0632-6138</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2019-10, Vol.14 (10), p.e0224069-e0224069 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2308691964 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Analysis Apnea Bayes Theorem Bayesian analysis Bioengineering Biology and Life Sciences Biophysics Cardiovascular diseases Care and treatment Clinical trials Continuous positive airway pressure Continuous Positive Airway Pressure - methods Cost analysis Cost benefit analysis Disease control Disease Management Female Health care costs Health sciences Hospitals Humans Male Management Medical diagnosis Medical economics Medicine Medicine and Health Sciences Methods Middle Aged Morbidity Patient compliance Patient Compliance - statistics & numerical data Patient satisfaction Patients People and places Quality of Life Questionnaires Randomization Research and Analysis Methods Risk factors Sleep Sleep and wakefulness Sleep apnea Sleep Apnea, Obstructive - economics Sleep Apnea, Obstructive - therapy Sleep disorders Sleepiness Social behavior Social factors Social interactions Social Sciences Studies Surveys and Questionnaires Technology Telemedicine Telemedicine - methods |
| title | Comprehensive management of obstructive sleep apnea by telemedicine: Clinical improvement and cost-effectiveness of a Virtual Sleep Unit. A randomized controlled trial |
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