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Exploring policy makers’ perspectives on a clinical controversy: airway surgery for adult obstructive sleep apnoea
  1. A G Elshaug1,2,3,
  2. J E Hiller1,2,3,
  3. J R Moss1
  1. 1
    Discipline of Public Health, University of Adelaide, Adelaide, Australia
  2. 2
    Adelaide Health Technology Assessment (AHTA), University of Adelaide, Australia
  3. 3
    Hanson Institute, Institute of Medical and Veterinary Science, Adelaide, Australia
  1. Correspondence to Dr Adam Elshaug, Discipline of Public Health, University of Adelaide, Level 3, 122 Frome St, Mail: DX 650 545, Adelaide, SA 5005, Australia; adam.elshaug{at}


Background and objectives: Worldwide, there is increasing focus on measures to reduce ineffective healthcare practices. Upper airway surgeries for the treatment of adult obstructive sleep apnoea (OSA) represent a case-study in this area, given recent publications that draw into question their efficacy. Policy stakeholders were canvassed to assess their perspectives on this.

Design and setting: Senior health policy stakeholders from Australia were criterion and snowball sampled (to identify opinion leaders). Participants were presented with preparatory material and took part in individual semistructured interviews. These focused on eliciting responses to recently published evidence and a relevant Cochrane review. Questions were posed relating to clinical effectiveness and associated policy implications. Interviews were taped and transcribed for thematic analysis. Participant comments were de-identified.

Findings: Ten stakeholders were interviewed before saturation was reached. Thematic analysis highlighted participant concern with the diversity of procedures on offer, coupled with limited effectiveness (suggesting potential clinical uncertainty) and considerations therefore of resource allocation (potential opportunity cost). Stakeholders seem aware of the methodological complexities, the ethical issues raised and the role of patients in considerations regarding appropriateness. Finally, policy stakeholders acknowledge that these procedures appear appropriate only for a minority, with consensus that policy level restrictions to government funding for these procedures may be warranted.

Conclusion: This report highlights that this clinical controversy is of interest and relevance from a policy perspective with lessons and potential implications for clinical practice. It further highlights the need for clinical consensus on definitions of surgical “success” in treating this condition, as this forms an important pretext to policy considerations.

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  • Funding AGE received funding for this project from the Faculty of Health Sciences of the University of Adelaide where this work was undertaken. AGE holds a Hanson Institute Research Fellowship from the Institute of Medical and Veterinary Science (IMVS).

  • Competing interests JEH is the director and AGE is a Hanson Institute Fellow of Adelaide Health Technology Assessment. This organisation is contracted to complete evaluations of health technologies. JRM provides healthcare assessments to the Australian government as a consultant. In all other respects, the authors declare they have no competing interests.

  • Patient consent Participants were contacted by email with an invitation to be involved, and response in the positive was construed as providing consent. Consent was obtained to audio record all interviews and to publish de-identified results in the form of a manuscript.