Original Title: État des connaissances - Appareils à pression positive continue pour le traitement de l'apnée obstructive du sommeil

Authors' objectives: The Institut national d’excellence en santé et en services sociaux (INESSS) was mandated by the Direction générale des affaires universitaires, médicales, infirmières et pharmaceutiques (DGAUMIP) of the Ministère de la Santé et des Services sociaux (MSSS) to produce a state-of-knowledge report on the public remboursement policies for continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA). In Quebec, OSA care includes identification of symptoms by a sleep medical doctor; sleep tests and patient diagnostic; treatment choice through collaboration between the patient and health professionals; and treatment support. According to the clinicians consulted, the diagnostic strategy is based more on the evaluation of symptoms than on measuring the severity of the disease (mild, moderate or severe) using different sleep tests. However, its estimated that nearly 80% of adults with OSA are not diagnosed. For coverage of expenses related to the CPAP device, it is estimated that 74% of diagnosed patients have a private insurance and 3.1% benefit from social assistance. The remaining patients currently have no coverage. To improve access to treatment, the Ministre de la Santé et des Services sociaux du Québec announced in April 2023 a measure, with recurring funding, for the reimbursement of CPAP devices. Terms and conditions of this reimbursement measure are not yet defined.

Authors' results and conclusions: RESULTS: (#1 POSITIVE PRESSURE TREATMENT): CPAP devices push air into the upper airways without interfering with the natural respiratory reflex. In Quebec, CPAP devices are the main indication for the treatment of adults and children with OSA. The adherence to CPAP treatment is about 57% amid adult patients, based on literature data that was confirmed by the clinicians consulted in this report. Treatment success depends, in part, on the quality of support provided by healthcare professionals and the telemonitoring of treatment adherence. (#2 PUBLIC COVERAGE IN OTHER COUNTRIES AND TERRITORIES): Two reimbursement models for CPAP devices have been identified in the literature. In some countries and territories, a joint public-private model partially funds the CPAP device and accessory purchases. This model covers access to treatment and separates the medical and technical parts of care delivery. Whereas in other countries and territories, a public model fully covers medical follow-up, patient support and equipment loans. (#3 TARGET POPULATION AND ECONOMIC ANALYSIS): A budgetary impact analysis was carried out by INESSS to quantify the expected financial impact of a public policy reimbursing CPAP devices for the treatment of OSA. The net cost per adult patient is estimated at $4,505 over 5 years, whereas this cost per pediatric patient is estimated at $8,847. Depending on the target population, the volume of patients (budgetary impact) over 5 years is estimated as follows: 354,884 individuals with coverage across the entire population ($1,408.3 million), at least 92,270 uninsured individuals ($366.1 million), or 24,198 low-income individuals not covered by Quebec’s social assistance ($96.0 million). The annual financial impact is estimated to increase by nearly 45% over 5 years, primarily due to accessory replacements. (#4 IMPLEMENTATION CONSIDERATIONS): According to the consultations carried out by INESSS, the introduction of a reimbursement policy in Quebec must consider the currently limited resources of healthcare facilities. The best practices in industry should also define the role of the private sector in the upcoming policy. Other elements that should be considered include prioritization of certain patient groups; significant under-diagnosis; treatment accessibility; reimbursement access criteria; and accessories and services included in the benefit. CONCLUSION: This state-of-knowledge report describes OSA care in Quebec and identifies the potential issues involved in implementing a public policy with a full or partial coverage for CPAP treatment. Depending on the objectives and the preferred approach, various parameters of this upcoming policy will need to be defined to ensure maximum benefit for patients. In addition, some uncertainties related to the availability of resources and the organization of services surrounding this reimbursement in Quebec have been highlighted and could hinder optimal implementation.

Authors' methods: The approach includes a rapid review of the scientific literature and a participatory process to collect contextual and experiential data for the treatment of OSA with CPAP. A budgetary impact analysis was also performed.

Project Status: Completed

URL for project: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/appareils-a-pression-positive-continue-pour-le-traitement-de-lapnee-obstructive-du-sommeil.html

Year Published: 2024

URL for published report: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/appareils-a-pression-positive-continue-pour-le-traitement-de-lapnee-obstructive-du-sommeil.html

English language abstract: An English language summary is available

Publication Type: Other

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)