Hypoglossal nerve stimulation for the treatment of obstructive sleep apnoea: a rapid HTA
Health technology assessment|
NIPH was asked to deliver a rapid health technology assessment about nerve stimulation in the treatment of obstructive sleep apnoea.
Obstructive sleep apnea (OSA) is a sleep disorder characterized by frequent interruption in breathing (apnoea) due to the narrowing or closure of the soft pharyngeal tissue while asleep. This is a risk factor for cardiovascular, neurological, and metabolic conditions. Current clinical practice involves treatment with continuous positive airway pressure (CPAP) during sleep. Many patients have a low tolerance for CPAP treatment, and the compliance rate can be as low as 50%. Hypoglossal nerve stimulation (HNS) is a possible alternative for patients who do not tolerate CPAP. The method, which is illustrated in this rapid HTA, keeps the airways open by stimulating the hypoglossal nerve during sleep.
Effect and safety: An HTA published by EUnetHTA in June 2020 included one randomized controlled trial (n = 46) and seven uncontrolled studies. The effect of hypoglossal nerve stimulation in the treatment of obstructive sleep apnea is generally very uncertain. Several relevant studies are expected to publish results in 2022 and 2023.
Severity: Severity is not calculated as this rapid HTA does not include a health economic assessment of cost-effectiveness.
Costs: The equipment costs are estimated at NOK 270,000 per patient. The clinical experts estimate that the first year will be 100 relevant patients but expect the use to increase with 25-30 percent each year. In such a scenario, the total annual costs for equipment will be estimated at NOK 27 million in the first year and NOK 72 million in year five. This estimate does not include cost related to the surgical procedures.