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

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.

• Authors: 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
• Journal: Circulation reports (Circ Rep) Vol. 2 Issue 9 Pg. 507-516 (Aug 27 2020) ISSN: 2434-0790 [Electronic] Japan
• PMID: 33693276 (Publication Type: Journal Article)
• Copyright: Copyright © 2020, THE JAPANESE CIRCULATION SOCIETY.