The invisible costs of obstructive sleep apnea (OSA): Systematic review and cost-of-illness analysis

Abstract

Background: Obstructive sleep apnea (OSA) is a risk factor for several diseases and is correlated with other non-medical consequences that increase the disease's clinical and economic burden. However, OSA's impact is highly underestimated, also due to substantial diagnosis gaps.

Objective: This study aims at assessing the economic burden of OSA in the adult population in Italy by performing a cost-of-illness analysis with a societal perspective. In particular, we aimed at estimating the magnitude of the burden caused by conditions for which OSA is a proven risk factor.

Methods: A systematic literature review on systematic reviews and meta-analyses, integrated by expert opinion, was performed to identify all clinical and non-clinical conditions significantly influenced by OSA. Using the Population Attributable Fraction methodology, a portion of their prevalence and costs was attributed to OSA. The total economic burden of OSA for the society was estimated by summing the costs of each condition influenced by the disease, the costs due to OSA's diagnosis and treatment and the economic value of quality of life lost due to OSA's undertreatment.

Results: Twenty-six clinical (e.g., diabetes) and non-clinical (e.g., car accidents) conditions were found to be significantly influenced by OSA, contributing to an economic burden ranging from €10.7 to €32.0 billion/year in Italy. The cost of impaired quality of life due to OSA undertreatment is between €2.8 and €9.0 billion/year. These costs are substantially higher than those currently borne to diagnose and treat OSA (€234 million/year).

Conclusions: This study demonstrates that the economic burden due to OSA is substantial, also due to low diagnosis and treatment rates. Providing reliable estimates of the economic impact of OSA at a societal level may increase awareness of the disease burden and help to guide evidence-based policies and prioritisation for healthcare, ultimately ensuring appropriate diagnostic and therapeutic pathways for patients.

Fig 1. Systematic literature review—Screening process (PRISMA flow diagram).

*Reasons for full-text exclusion: 1) OSA exclusively investigated as a consequence of other conditions; 2) no quantitative data provided on the association of OSA with other conditions; 3) focus on parameters that could eventually identify a clinical condition, but not on the clinical condition itself; 4) lack of a control group of non-OSA patients; 5) unclear data on the direction of the association between OSA and the condition investigated; 6) focus on OSA together with other sleep disorders; 7) measure of association that could not be used for PAF calculation; 8) association between increase in AHI and the condition investigated.

Fig 2. Tornado plot for sensitivity analysis (model 1).

Fig 3. Tornado plot for sensitivity analysis (model 2).