Health state utilities associated with obstructive sleep apnea: preferences of patients with OSA and obesity in the UK and the US

Abstract

Introduction: Obstructive sleep apnea (OSA) is characterized by repeated episodes of airway obstruction during sleep, resulting in intermittent hypoxia, disrupted sleep, and reduced quality of life. Obesity management medications may provide new options for patients with OSA and obesity. Health state utilities will be needed as inputs in economic modeling conducted to inform decision-making about these medications for treatment of OSA. The purpose of this study was to estimate utilities associated with OSA severity based on preferences of individuals with OSA and obesity. Methods: Participants with OSA and obesity (BMI ≥ 30) in the UK and US valued health state vignettes in time trade-off interviews. Vignettes described four levels of OSA severity defined by apnea-hypopnea index: remission (<5), mild (5–14.9), moderate (15–29.9), and severe (≥30). Participants were instructed to imagine having the option to use non-pharmacologic treatment for OSA when valuing the health states. Utilities were first estimated for OSA with these treatment options. Then, for health states where participants imagined using positive airway pressure or another device, they were asked to value the vignettes a second time without this treatment to estimate utilities associated with symptoms of OSA at each severity level. Results: A total of 208 participants (UK = 105; US = 103) completed interviews (50.0% male; mean age = 53.6y). Mean (SD) utilities ranged from 0.93 (0.08) for mild OSA to 0.85 (0.15) for severe OSA when considering health states with the option to use non-pharmacologic treatment. When participants imagined living with the symptoms of OSA without the non-pharmacologic treatment option, mean utilities ranged from 0.89 (0.13) for mild OSA to 0.68 (0.27) for severe OSA. Discussion: Results provide insight into preferences associated with OSA among people with OSA and obesity. The health state utilities estimated in this study may be useful in cost-effectiveness models evaluating treatments for OSA in individuals with obesity.