ResUHUrge: A Low Cost and Fully Functional Ventilator Indicated for Application in COVID-19 Patients.

Although the cure for the SARS-CoV-2 virus (COVID-19) will come in the form of pharmaceutical solutions and/or a vaccine, one of the only ways to face it at present is to guarantee the best quality of health for patients, so that they can overcome the disease on their own. Therefore, and considering that COVID-19 generally causes damage to the respiratory system (in the form of lung infection), it is essential to ensure the best pulmonary ventilation for the patient. However, depending on the severity of the disease and the health condition of the patient, the situation can become critical when the patient has respiratory distress or becomes unable to breathe on his/her own. In that case, the ventilator becomes the lifeline of the patient. This device must keep patients stable until, on their own or with the help of medications, they manage to overcome the lung infection. However, with thousands or hundreds of thousands of infected patients, no country has enough ventilators. If this situation has become critical in the Global North, it has turned disastrous in developing countries, where ventilators are even more scarce. This article shows the race against time of a multidisciplinary research team at the University of Huelva, UHU, southwest of Spain, to develop an inexpensive, multifunctional, and easy-to-manufacture ventilator, which has been named ResUHUrge. The device meets all medical requirements and is developed with open-source hardware and software.

Cost-Effectiveness of the Aerobika® Oscillating Positive Expiratory Pressure Device in the Management of Chronic Obstructive Pulmonary Disease Exacerbations in Canada.

Background: The Aerobika® oscillating positive expiratory pressure (OPEP) device is a hand-held, drug-free medical device that has been shown to improve lung function and improve health-related quality of life in patients with chronic obstructive pulmonary disease (COPD). We estimated the cost-effectiveness of this device among postexacerbation COPD patients in the Canadian healthcare system. Methods: We performed a cost-utility analysis using a Markov model to compare both costs and outcome of patients with COPD who had recently experienced an exacerbation between 2 treatment arms: patients who used the Aerobika® device and patients who did not use the Aerobika® device. This cost-utility analysis included costs based on the Alberta healthcare system perspective as these represent Canadian experience. A one-year horizon with 12 monthly cycles was used. Results: For a patient after 1 year, the use of the Aerobika® device would save $694 in healthcare costs and produce 0.04 more in quality-adjusted life years (QALYs) in comparison with no positive expiratory pressure (PEP)/OPEP therapy. In other words, the economic outcome of the device was dominant (i.e., more effective and less costly). The probability for this device to be the dominant strategy was 72%. With a willingness to pay (WTP) threshold of $50,000 per QALY gained, the probability for the Aerobika® device to be cost-effective was 77%. Conclusions: Given one of the major treatment goals in the GOLD guidelines is to minimize the negative impact of exacerbations and prevent re-exacerbations, the Aerobika® OPEP device should be viewed as a potential component of a treatment strategy to improve symptom control and reduce the risk of re-exacerbations in patients with COPD.

Cost-effectiveness of the Aerobika* oscillating positive expiratory pressure device in the management of COPD exacerbations.

INTRODUCTION: COPD places a huge clinical and economic burden on the US health care system, with acute exacerbations representing a key driver of direct medical costs. Current treatments, although effective in reducing symptoms and limiting exacerbations, do not adequately target the underlying disease processes that drive exacerbation development. The Aerobika* oscillating positive expiratory pressure (OPEP) device has been shown in a real-world effectiveness study to lower the frequency of moderate-to-severe exacerbations during a 30-day post-exacerbation period. This study sought to determine the impact on exacerbations and costs and to determine the cost-effectiveness of the Aerobika* device. METHODS: Data from published literature and national fee schedules were used to model the cost-effectiveness of the Aerobika* device in patients who had experienced an exacerbation in the previous month, or a post-exacerbation care population. Exacerbation trends and the impact of the Aerobika* device on reducing exacerbation frequency were modeled using a one-year Markov model with monthly cycles and three health states: (i) no exacerbation, (ii) exacerbation, and (iii) death. Scenario analysis and one-way sensitivity analysis (OWSA) were also performed. RESULTS: When the effect of Aerobika* device was assumed to last 30 days, use of the device resulted in cost-savings ($553 per patient) and improved outcomes (ie, six fewer exacerbations per 100 patients per year) compared to no OPEP/positive expiratory pressure therapy. When the effect of the Aerobika* device was assumed to extend beyond the conservative 30-day time frame, the Aerobika* device remained the dominant strategy (21 fewer exacerbations per 100 patients per year; cost savings of $1,952 per patient). Consistency in findings after performing OWSAs indicates the robustness of results. CONCLUSION: The Aerobika* device is a cost-effective treatment option that provides clinical benefit and results in direct medical cost savings in a post-exacerbation care COPD population.

Cost Savings from Reduced Hospitalizations with Use of Home Noninvasive Ventilation for COPD.

BACKGROUND: Although evidence suggests significant clinical benefits of home noninvasive ventilation (NIV) for management of severe chronic obstructive pulmonary disease (COPD), economic analyses supporting the use of this technology are lacking. OBJECTIVES: To evaluate the economic impact of adopting home NIV, as part of a multifaceted intervention program, for severe COPD. METHODS: An economic model was developed to calculate savings associated with the use of Advanced NIV (averaged volume assured pressure support with autoexpiratory positive airway pressure; Trilogy100, Philips Respironics, Inc., Murrysville, PA) versus either no NIV or a respiratory assist device with bilevel pressure capacity in patients with severe COPD from two distinct perspectives: the hospital and the payer. The model examined hospital savings over 90 days and payer savings over 3 years. The number of patients with severe COPD eligible for home Advanced NIV was user-defined. Clinical and cost data were obtained from a quality improvement program and published reports. Scenario analyses calculated savings for hospitals and payers covering different COPD patient cohort sizes. RESULTS: The hospital base case (250 patients) revealed cumulative savings of $402,981 and $449,101 over 30 and 90 days, respectively, for Advanced NIV versus both comparators. For the payer base case (100,000 patients), 3-year cumulative savings with Advanced NIV were $326 million versus no NIV and $1.04 billion versus respiratory assist device. CONCLUSIONS: This model concluded that adoption of home Advanced NIV with averaged volume assured pressure support with autoexpiratory positive airway pressure, as part of a multifaceted intervention program, presents an opportunity for hospitals to reduce COPD readmission-related costs and for payers to reduce costs associated with managing patients with severe COPD on the basis of reduced admissions.

Análisis coste-efectividad del tratamiento con presión positiva continua de la vía aérea en el síndrome de apnea-hipopnea durante el sueño (SAHS) moderado-grave / Cost-effectiveness of Continuous Positive Airway Pressure Treatment in Moderate-Severe Obstructive Sleep Apnea Syndrome

Introducción: El síndrome de apnea-hipopnea durante el sueño (SAHS) supone un gran impacto socioeconómico. El objetivo de este estudio es evaluar el coste-efectividad del tratamiento del SAHS con presión positiva continua de la vía aérea superior (CPAP) y estimar la influencia que tiene el cumplimiento de la CPAP. Métodos: Estudio retrospectivo de «casos cruzados» de 373 pacientes SAHS tratados con CPAP. Se calcularon variaciones en costes, puntuación en el test de Epworth y calidad de vida relacionada con la salud (cuestionario EQ-5D) entre el año previo al tratamiento y el año después del mismo. Se estimó la ratio de coste-efectividad incremental (RCEI) para el primer año de tratamiento y se realizó una proyección para el segundo año bajo distintos escenarios de efectividad y costes. Resultados: La puntuación de la escala visual analógica del cuestionario EQ-5D aumentó en 5 puntos y el test de Epworth disminuyó en 10 puntos al año del tratamiento con CPAP, con una ganancia media en años de vida ajustados por calidad (AVAC) de 0,05 por paciente y año (p < 0,001): 0,07 en cumplidores y -0,04 en no cumplidores. La RCEI fue de 51.147 €/AVAC durante el primer año de tratamiento con CPAP y de 1.544 €/AVAC el segundo año. Conclusión: El tratamiento con CPAP en pacientes con SAHS moderado-grave mejora la calidad de vida de los pacientes cumplidores y es coste-efectivo a partir del segundo año

Introduction: The socioeconomic impact of obstructive sleep apnea-hypopnea syndrome (OSAHS) is considerable. The aim of this study was to evaluate the cost-effectiveness of treating OSAHS with continuous positive airway pressure (CPAP) and the impact of CPAP compliance. Methods: This was a retrospective, case-crossover study of 373 patients with OSAHS receiving CPAP. We compared changes in costs, Epworth score and health-related quality of life (EQ-5D questionnaires) between the year before treatment and the year after treatment. The incremental cost-effectiveness ratio (ICER) for the first year of treatment was estimated, and projections were made for the second year, using different effectiveness and cost scenarios. Results: The visual analog scale score for the EQ-5D questionnaire increased by 5 points and the Epworth score fell by 10 points during the year of CPAP treatment. Mean gain in quality-adjusted life years (QALY) was 0.05 per patient per year (P < .001): 0.07 among compliers and -0.04 among non-compliers. ICER was €51,147/QALY during the first year of CPAP treatment and €1,544/QALY during the second year. Conclusion: CPAP treatment in patients with moderate-severe OSAHS improves the quality of life of compliant patients, and is cost-effective as of the second year

Cost-benefit analysis of polysomnography versus Clinical Assessment Score-15 (CAS-15) for treatment of pediatric sleep-disordered breathing.

OBJECTIVE: To determine the cost of medical care using the Clinical Assessment Score-15 (CAS-15) scale versus polysomnography (PSG) for children with sleep-disordered breathing in terms of benefit. STUDY DESIGN: Cost-benefit analysis. SETTING: Hospital-based pediatric otolaryngology practice. SUBJECTS AND METHODS: Ninety-three patients from our original CAS-15 study were included. Four clinical measures were used and payment data were obtained. Cost-benefit analysis was performed for 2 clinical pathways. In pathway 1, all children had PSG; those with positive studies were referred for adenotonsillectomy. In pathway 2, children with CAS-15 ≥ 32 were referred for adenotonsillectomy regardless of PSG. Paired t test compared intrasubject mean total cost (pathway 1 vs pathway 2). Further analyses computed a change score for the clinical measures (follow-up minus baseline); these were divided by estimated treatment cost, producing 4 cost-benefit ratios for each pathway. Paired t tests compared the mean of these ratios between the pathways. RESULTS: Of 65 PSG+ (15 CAS-), 54 underwent surgery; of 28 PSG- (17 CAS-), 7 underwent surgery. Model estimated costs demonstrate a mean cost benefit of $US1172 (SE = $214) for pathway 2 versus pathway 1 (P < .001). CAS-15 is also cost-beneficial versus PSG in 3 of 4 clinical measures (Child Behavior Checklist total problem T score, P = .008, mean OSA-18 survey score, P < .001, apnea hypopnea index, P < .001). CONCLUSIONS: We present evidence that a CAS-15-based treatment decision criterion is superior to PSG in terms of monetary cost and in benefit per unit cost for 3 of 4 clinical measures evaluated.

Noninvasive ventilation in acute severe asthma: current evidence and future perspectives.

PURPOSE OF REVIEW: The use of noninvasive positive pressure ventilation (NPPV) is often employed for the management of acute respiratory failure as an alternative to endotracheal intubation and mechanical ventilation. However, evidence to support the application of NPPV use in patients with acute severe asthma is less known. RECENT FINDINGS: A paucity of evidence is available to support the use of NPPV as part of clinical care in patients with acute severe asthma. A number of small studies in adult and paediatric populations suggest that NPPV may have a beneficial role through improving respiratory rate and reducing the need for more invasive alternatives. Overall NPPV use appeared to be well tolerated with few reports of adverse events. SUMMARY: Available evidence is limited by a small number of published trials and lack of methodological rigour in existing study design. There is a need for well conducted clinical studies to establish accurate treatment efficacy, safety and cost-effectiveness, in both the adult and paediatric setting.

A timeline for predicting durable medical equipment needs and interventions for amyotrophic lateral sclerosis patients.

ALS is progressive with increasing patient needs for durable medical equipment (DME) and interventions (gastric feeding tube - PEG, and non-invasive ventilation - NIV). We performed a chart review of deceased patients to determine the time-course of needs and their estimated costs. A timeline of needs was based on when clinic personnel felt an item was necessary. The point in time when an item or intervention was needed was expressed as a percentage of a patient's total disease duration. A wide range of DME and interventions was needed irrespective of site of ALS symptom onset (bulbar, upper, lower extremity), beginning at 10% of disease duration of lower extremity onset and increasing thereafter for all sites. The cumulative probability of costs of items and interventions began at 25%-50% of disease duration and increased to between $18,000 and $32,000 (USD), highest for lower extremity onset due to the cost of wheelchairs. We conclude that a high percentage of ALS patients will need a full spectrum of major DME items and interventions during the second half of disease duration. This results in a linear rise in costs over the second half of the disease duration.

Non-invasive ventilation in acute respiratory failure.

Non-invasive mechanical ventilation has been increasingly used to avoid or serve as an alternative to intubation. Compared with medical therapy, and in some instances with invasive mechanical ventilation, it improves survival and reduces complications in selected patients with acute respiratory failure. The main indications are exacerbation of chronic obstructive pulmonary disease, cardiogenic pulmonary oedema, pulmonary infiltrates in immunocompromised patients, and weaning of previously intubated stable patients with chronic obstructive pulmonary disease. Furthermore, this technique can be used in postoperative patients or those with neurological diseases, to palliate symptoms in terminally ill patients, or to help with bronchoscopy; however further studies are needed in these situations before it can be regarded as first-line treatment. Non-invasive ventilation implemented as an alternative to intubation should be provided in an intensive care or high-dependency unit. When used to prevent intubation in otherwise stable patients it can be safely administered in an adequately staffed and monitored ward.

A multicentre randomised controlled trial of the use of continuous positive airway pressure and non-invasive positive pressure ventilation in the early treatment of patients presenting to the emergency department with severe acute cardiogenic pulmonary oedema: the 3CPO trial.

OBJECTIVES: To determine whether non-invasive ventilation reduces mortality and whether there are important differences in outcome by treatment modality. DESIGN: Multicentre open prospective randomised controlled trial. SETTING: Patients presenting with severe acute cardiogenic pulmonary oedema in 26 emergency departments in the UK. PARTICIPANTS: Inclusion criteria were age > 16 years, clinical diagnosis of acute cardiogenic pulmonary oedema, pulmonary oedema on chest radiograph, respiratory rate > 20 breaths per minute, and arterial hydrogen ion concentration > 45 nmol/l (pH < 7.35). INTERVENTIONS: Patients were randomised to standard oxygen therapy, continuous positive airway pressure (CPAP) (5-15 cmH2O) or non-invasive positive pressure ventilation (NIPPV) (inspiratory pressure 8-20 cmH2O, expiratory pressure 4-10 cmH2O) on a 1:1:1 basis for a minimum of 2 hours. MAIN OUTCOME MEASURES: The primary end point for the comparison between NIPPV or CPAP and standard therapy was 7-day mortality. The composite primary end point for the comparison of NIPPV and CPAP was 7-day mortality and tracheal intubation rate. Secondary end points were breathlessness, physiological variables, intubation rate, length of hospital stay and critical care admission rate. Economic evaluation took the form of a cost-utility analysis, taken from an NHS (and personal social services) perspective. RESULTS: In total, 1069 patients [mean age 78 (SD 10) years; 43% male] were recruited to standard therapy (n = 367), CPAP [n = 346; mean 10 (SD 4) cmH2O] or NIPPV [n = 356; mean 14 (SD 5)/7 (SD 2) cmH2O]. There was no difference in 7-day mortality for standard oxygen therapy (9.8%) and non-invasive ventilation (9.5%; p = 0.87). The combined end point of 7-day death and intubation rate was similar, irrespective of non-invasive ventilation modality (CPAP 11.7% versus NIPPV 11.1%; p = 0.81). Compared with standard therapy, non-invasive ventilation was associated with greater reductions (treatment difference, 95% confidence intervals) in breathlessness (visual analogue scale score 0.7, 0.2-1.3; p = 0.008) and heart rate (4/min, 1-6; p = 0.004) and improvement in acidosis (pH 0.03, 0.02-0.04; p < 0.001) and hypercapnia (0.7 kPa, 0.4-0.9; p < 0.001) at 1 hour. There were no treatment-related adverse events or differences in other secondary outcomes such as myocardial infarction rate, length of hospital stay, critical care admission rate and requirement for endotracheal intubation. Economic evaluation showed that mean costs and QALYs up to 6 months were 3023 pounds and 0.202 for standard therapy, 3224 pounds and 0.213 for CPAP, and 3208 pounds and 0.210 for NIPPV. Modelling of lifetime costs and QALYs produced values of 15,764 pounds and 1.597 for standard therapy, 17,525 pounds and 1.841 for CPAP, and 17,021 pounds and 1.707 for NIPPV. These results suggest that both CPAP and NIPPV accrue more QALYs but at higher cost than standard therapy. However, these estimates are subject to substantial uncertainty. CONCLUSIONS: Non-invasive ventilatory support delivered by either CPAP or NIPPV safely provides earlier improvement and resolution of breathlessness, respiratory distress and metabolic abnormality. However, this does not translate into improved short- or longer-term survival. We recommend that CPAP or NIPPV should be considered as adjunctive therapy in patients with severe acute cardiogenic pulmonary oedema in the presence of severe respiratory distress or when there is a failure to improve with pharmacological therapy. TRIAL REGISTRATION: Current Controlled Trials ISRCTN07448447.

[Non invasive ventilation: how, when and why?]. / Ventilatia non invaziva: cum, când si de ce?

Use of non invasive ventilation (NIV), the delivery of mechanical ventilation without endotracheal intubation, is increasing among patients with acute and chronic respiratory failure, mainly because of its convenience, lower cost, morbidity sparing potential compared with standard invasive technique. An understanding of the technical equipment, the classification, modes of ventilation and the selection of an appropriate interface are necessary for the best outcomes. The parameters which should be monitored during noninvasive ventilation are presented. The majority of studies have used pressure-targeted ventilation in the assist mode. Positive qualities of pressure support ventilation (PSV) are leak compensation, good patient/ventilator synchrony and the option of integrated positive end-expiratory pressure to counteract the effect of dynamic hyperinflation. The interface between patient and ventilator is a crucial issue of noninvasive ventilation. Advantages and disadvantages of face and nasal masks are discussed. The beneficial effects of NIV have been demonstrated in patients with respiratory acidosis (pH < 7.35). Arterial blood gas tensions should be measured in most patients with acute breathlessness.

Análisis de coste-eficacia de la graduación automática de la presión positiva continua de la vía aérea en el domicilio: ¿una o 2 noches? / Cost-effectiveness analysis of automatic titration of continuous positive airway pressure at home in 1 night versus 2 nights

OBJETIVO: Evaluar el coste-eficacia de la graduaciónautomática de la presión positiva continua de la vía aérea(CPAP) en el domicilio, en una y 2 noches consecutivas, enpacientes con síndrome de apneas-hiponeas durante el sueño.PACIENTES Y MÉTODOS: Se practicó un estudio degraduación domiciliaria con un equipo de CPAP automática(APAP) durante 2 noches consecutivas a 100 pacientes consíndrome de apneas-hipopneas durante el sueño e indicaciónde tratamiento con CPAP. Se evaluaron el número deestudios satisfactorios y el coste resultante de la primeranoche y de las 2 noches. Se compararon las necesidades depresión durante cada noche y la concordancia entre lapresión seleccionada visualmente por 2 observadores.RESULTADOS: La graduación de CPAP fue satisfactoria enel 85 y el 80% de los pacientes en la primera y la segundanoches, respectivamente, y en el 88% después de las 2noches. No hubo diferencias significativas entre las 2 nochesen la presión percentil 95% (media ± desviación estándar:10,2 ± 1,8 y 10,2 ± 1,6 cmH2O), la presión media (7,8 ± 1,7 y7,7 ± 1,7 cmH2O) y la presión visual (9,4 ± 1,5 y 9,4 ± 1,4cmH2O). Se obtuvo un buen grado de concordancia entre 2observadores en la selección de presión (kappa = 0,956 parala noche 1; kappa = 0,91 para la noche 2). El coste de losestudios fue 232,63 € para la primera noche y 227,93 € paralas 2 noches consecutivas.CONCLUSIONES: Con un coste similar, la adopción de unprotocolo de graduación automática de la CPAP una noche enel domicilio permite incrementar sustancialmente el númerode pacientes estudiados, respecto a 2 noches consecutivas

OBJECTIVE: To assess the cost-effectiveness of automaticcontinuous positive airway pressure (CPAP) titration athome on 1 night or 2 consecutive nights in patients with thesleep apnea-hypopnea syndrome (SAHS).PATIENTS AND METHODS: A home titration study wasperformed using automatic CPAP for 2 consecutive nightson 100 patients with SAHS and an indication for CPAP. Thenumber of successful studies and the costs of the first nightand both nights were analyzed. The pressure requirementson each night and the agreement between the pressuresselected visually by 2 different observers were compared.RESULTS: CPAP titration was successful in 85% and 80%of patients on the first night and second night, respectively,and in 88% of patients after both nights. No significantdifferences between the 2 nights were found for the followingparameters: 95th percentile pressure (mean [SD], 10.2 [1.8]cm H2O and 10.2 [1.6] cm H2O on the first and secondnights, respectively), mean pressure (7.8 [1.7] cm H2O and7.7 [1.7] cm H2O), or the pressure selected visually (9.4 [1.5]cm H2O and 9.4 [1.4] cm H2O). Interobserver agreement onthe pressure selected was good: the k statistics were 0.956 forthe first night and 0.91 for the second night. The 1-nightstudy cost €232.63 and the 2-night study cost €227.93.CONCLUSIONS: Automatic CPAP titration at home for1 night enables a substantially greater number of patients tobe studied at a similar cost than is possible when titration isaccomplished in 2 consecutive nights

The cost-effectiveness of early noninvasive ventilation for ALS patients.

BACKGROUND: Optimal timing of noninvasive positive pressure ventilation (NIPPV) initiation in patients with amyotrophic lateral sclerosis (ALS) is unknown, but NIPPV appears to benefit ALS patients who are symptomatic from pulmonary insufficiency. This has prompted research proposals of earlier NIPPV initiation in the ALS disease course in an attempt to further improve ALS patient quality of life and perhaps survival. We therefore used a cost-utility analysis to determine a priori what magnitude of health-related quality of life (HRQL) improvement early NIPPV initiation would need to achieve to be cost-effective in a future clinical trial. METHODS: Using a Markov decision analytic model we calculated the benefit in health-state utility that NIPPV initiated at ALS diagnosis must achieve to be cost-effective. The primary outcome was the percent utility gained through NIPPV in relation to two common willingness-to-pay thresholds: 50,000 dollars and 100,000 dollars per quality-adjusted life year (QALY). RESULTS: Our results indicate that if NIPPV begun at the time of diagnosis improves ALS patient HRQL as little as 13.5%, it would be a cost-effective treatment. Tolerance of NIPPV (assuming a 20% improvement in HRQL) would only need to exceed 18% in our model for treatment to remain cost-effective using a conservative willingness-to-pay threshold of 50,000 dollars per QALY. CONCLUSION: If early use of NIPPV in ALS patients is shown to improve HRQL in future studies, it is likely to be a cost-effective treatment. Clinical trials of NIPPV begun at the time of ALS diagnosis are therefore warranted from a cost-effectiveness standpoint.

Screening for obstructive sleep apnea in stroke patients: a cost-effectiveness analysis.

BACKGROUND AND PURPOSE: Obstructive sleep apnea (OSA) is common after acute ischemic stroke and predicts poor stroke recovery, but whether screening for OSA and treatment by continuous positive airway pressure (CPAP) improves neurological outcome is unknown. We used a cost-effectiveness model to estimate the magnitude of benefit that would be necessary to make polysomnography (PSG) and OSA treatment cost-effective in stroke patients. METHODS: A decision tree modeled 2 alternative strategies: PSG followed by 3 months of CPAP for those found to have OSA versus no screening. The primary outcome was the utility gained through OSA screening and treatment in relation to 2 common willingness-to-pay thresholds of $50,000 and $100,000 per quality-adjusted life year (QALY). RESULTS: Screening resulted in an incremental cost-effectiveness ratio of $49,421 per QALY. Screening is cost-effective as long as the treatment of stroke patients with OSA by CPAP improves patient utilities by >0.2 for a willingness-to-pay of $50,000 per QALY and 0.1 for a willingness-to-pay of $100,000 per QALY. CONCLUSIONS: A clinical trial assessing the effectiveness of CPAP in improving stroke outcome is warranted from a cost-effectiveness standpoint.

Reducing motor-vehicle collisions, costs, and fatalities by treating obstructive sleep apnea syndrome.

STUDY OBJECTIVES: Drivers suffering from obstructive sleep apnea syndrome (OSAS) have an increased risk for being involved in motor-vehicle collisions. This study estimates, for the first time, the annual OSAS-related collisions, costs, and fatalities in the United States and performs a cost-benefit analysis of treating drivers suffering from OSAS with continuous positive airway pressure (CPAP). DESIGN: The MEDLINE-PubMed database (1980 to 2003) was searched for information on OSAS. A meta-analysis was performed of studies investigating the relationship between collisions and OSAS. Data from the National Safety Council were used to estimate OSAS-related collisions, costs, and fatalities and their reduction with treatment. Next, the annual cost of treating OSAS with CPAP was calculated. Finally, multiple 1-way sensitivity analyses were performed. SETTING: N/A. PATIENTS OR PARTICIPANTS: N/A. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: More than 800,000 drivers were involved in OSAS-related motor-vehicle collisions in the year 2000. These collisions cost 15.9 billion dollars and 1,400 lives in the year 2000. In the United States, treating all drivers suffering from OSAS with CPAP would cost 3.18 billion dollars, save 11.1 billion dollars in collision costs, and save 980 lives annually. CONCLUSION: Annually, a small but significant portion of motor-vehicle collisions, costs, and deaths are related to OSAS. With CPAP treatment, most of these collisions, costs, and deaths can be prevented. Treatment of OSAS benefits both the patient and the public.