Cost-Effectiveness of a Community Pharmacist-Led Sleep Apnea Screening Program – A Markov Model

BACKGROUND: Despite the high prevalence and major public health ramifications, obstructive sleep apnea syndrome (OSAS) remains underdiagnosed. In many developed countries, because community pharmacists (CP) are easily accessible, they have been developing additional clinical services that integrate the services of and collaborate with other healthcare providers (general practitioners (GPs), nurses, etc.). Alternative strategies for primary care screening programs for OSAS involving the CP are discussed. OBJECTIVE: To estimate the quality of life, costs, and cost-effectiveness of three screening strategies among patients who are at risk of having moderate to severe OSAS in primary care. DESIGN: Markov decision model. DATA SOURCES: Published data. TARGET POPULATION: Hypothetical cohort of 50-year-old male patients with symptoms highly evocative of OSAS. TIME HORIZON: The 5 years after initial evaluation for OSAS. PERSPECTIVE: Societal. INTERVENTIONS: Screening strategy with CP (CP-GP collaboration), screening strategy without CP (GP alone) and no screening. OUTCOMES MEASURES: Quality of life, survival and costs for each screening strategy. RESULTS OF BASE-CASE ANALYSIS: Under almost all modeled conditions, the involvement of CPs in OSAS screening was cost effective. The maximal incremental cost for “screening strategy with CP” was about 455€ per QALY gained. RESULTS OF SENSITIVITY ANALYSIS: Our results were robust but primarily sensitive to the treatment costs by continuous positive airway pressure, and the costs of untreated OSAS. The probabilistic sensitivity analysis showed that the “screening strategy with CP” was dominant in 80% of cases. It was more effective and less costly in 47% of cases, and within the cost-effective range (maximum incremental cost effectiveness ratio at €6186.67/QALY) in 33% of cases. CONCLUSIONS: CP involvement in OSAS screening is a cost-effective strategy. This proposal is consistent with the trend in Europe and the United States to extend the practices and responsibilities of the pharmacist in primary care.