A Bayesian cost-effectiveness analysis of a telemedicine-based strategy for the management of sleep apnoea: A multicentre randomised controlled trial

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Publicated to:Thorax. 70 (11): 1054-1061 - 2015-11-01 70(11), DOI: 10.1136/thoraxjnl-2015-207032

Authors: Isetta, Valentina; Negrin, Miguel A; Monasterio, Carmen; Masa, Juan F; Feu, Nuria; Alvarez, Ainhoa; Campos-Rodriguez, Francisco; Ruiz, Concepcion; Abad, Jorge; Farre, Ramon; Galdeano, Marina; Lloberes, Patricia; Embid, Cristina; de la Pena, Monica; Puertas, Javier; Dalmases, Mireia; Salord, Neus; Corral, Jaime; Leon, Carmen; Egea, Carlos; Munoz, Aida; Parra, Olga; Cambrodi, Roser; Arque, Meritxell

Affiliations

Ctr Invest Biomed Red Enfermedades Resp CIBERS, Madrid, Spain CIBERES CIBER - Centro de Investigacion Biomedica en Red - Author

Hosp San Pedro Alcantara, Serv Neumol, Caceres, Spain - Author

Hosp Univ Araba, Unidad Func Sueno, Vitoria, Gasteiz, Spain University Hospital of Araba - Author

Hosp Univ Bellvitge, Serv Neumol, Unidad Sueno, IDIBELL, Barcelona, Spain Catalan Health Institute Institut d'Investigacio Biomedica de Bellvitge (IDIBELL) Bellvitge University Hospital - Author

Hosp Univ La Ribera, Dept Neurofisiol Clin, Valencia, Spain - Author

Hosp Univ La Ribera, Unidad Sueno, Valencia, Spain - Author

Hosp Univ Son Espases, Serv Neumol, Palma De Mallorca, Spain Hospital Universitario Son Espases - Author

Hosp Univ Vall dHebron, Unidad Sueno, Serv Neumol, Barcelona, Spain Hospital Universitari Vall d'Hebron - Author

Hosp Univ Valme, Serv Neumol, Seville, Spain Hospital Valme - Author

Inst Invest Biomed August Pi i Sunyer IDIBAPS, Barcelona, Spain University of Barcelona IDIBAPS Hospital Clinic de Barcelona - Author

Univ Autonoma Barcelona, Hosp Germans Trias & Pujol, Serv Neumol, Badalona, Spain Hospital Germans Trias i Pujol Autonomous University of Barcelona - Author

Univ Barcelona, Fac Med, Unitat Biofis & Bioengn, Casanova 143, E-08036 Barcelona, Spain. University of Barcelona - Author

Univ Barcelona, Fac Med, Unitat Biofis & Bioengn, E-08036 Barcelona, Spain University of Barcelona - Author

Univ Barcelona, Hosp Clin Barcelona, Unidad Sueno, Serv Neumol, Barcelona, Spain Hospital Clinic de Barcelona University of Barcelona - Author

Univ Barcelona, Hosp Univ Sagrat Cor, Serv Neumol, Barcelona, Spain University of Barcelona - Author

Univ Cordoba, Hosp Univ Reina Sofia, Unidad Sueno, IMIBIC, Cordoba, Spain Universidad de Cordoba Hospital Universitario Reina Sofia - Author

Univ Las Palmas Gran Canaria, Dept Metodos Cuantitat, Las Palmas Gran Canaria, Islas Canarias, Spain Universidad de Las Palmas de Gran Canaria - Author

Univ Las Palmas Gran Canaria, TiDES Inst, Las Palmas Gran Canaria, Islas Canarias, Spain Universidad de Las Palmas de Gran Canaria - Author

Univ Valencia, Dept Fisiol, Valencia, Spain University of Valencia - Author

Abstract

Compliance with continuous positive airway pressure (CPAP) therapy is essential in patients with obstructive sleep apnoea (OSA), but adequate control is not always possible. This is clinically important because CPAP can reverse the morbidity and mortality associated with OSA. Telemedicine, with support provided via a web platform and video conferences, could represent a cost-effective alternative to standard care management.To assess the telemedicine impact on treatment compliance, cost-effectiveness and improvement in quality of life (QoL) when compared with traditional face-to-face follow-up.A randomised controlled trial was performed to compare a telemedicine-based CPAP follow-up strategy with standard face-to-face management. Consecutive OSA patients requiring CPAP treatment, with sufficient internet skills and who agreed to participate, were enrolled. They were followed-up at 1, 3 and 6 months and answered surveys about sleep, CPAP side effects and lifestyle. We compared CPAP compliance, cost-effectiveness and QoL between the beginning and the end of the study. A Bayesian cost-effectiveness analysis with non-informative priors was performed.We randomised 139 patients. At 6 months, we found similar levels of CPAP compliance, and improved daytime sleepiness, QoL, side effects and degree of satisfaction in both groups. Despite requiring more visits, the telemedicine group was more cost-effective: costs were lower and differences in effectiveness were not relevant.A telemedicine-based strategy for the follow-up of CPAP treatment in patients with OSA was as effective as standard hospital-based care in terms of CPAP compliance and symptom improvement, with comparable side effects and satisfaction rates. The telemedicine-based strategy had lower total costs due to savings on transport and less lost productivity (indirect costs).NCT01716676.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Keywords

adherencecpaptherapyBayes theoremContinuous positive airway pressureCost-benefit analysisDisease managementFemaleFollow-up studiesHumansMaleMiddle agedPatient compliancePositive airway pressureProspective studiesQuality of lifeSleepSleep apnea, obstructiveSleep apnoeaTelemedicine

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Thorax due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2015, it was in position 4/58, thus managing to position itself as a Q1 (Primer Cuartil), in the category Respiratory System.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 2.68. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

Weighted Average of Normalized Impact by the Scopus agency: 3.48 (source consulted: FECYT Feb 2024)
Field Citation Ratio (FCR) from Dimensions: 34.14 (source consulted: Dimensions Jun 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-06-30, the following number of citations:

WoS: 86
Scopus: 101
Europe PMC: 58

Impact and social visibility

Leadership analysis of institutional authors

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: First Author (Isetta, Valentina) and Last Author (Torres de Dalmases, Carme).

the author responsible for correspondence tasks has been Isetta, Valentina.

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