Sleep Apnea Oral Appliance vs. CPAP Cost-Benefit Calculator

Balancing cost and real-world use (CPAP vs. oral appliance)

Continuous positive airway pressure (CPAP) is widely used for obstructive sleep apnea (OSA), but comfort, travel, noise, and mask fit can affect how consistently someone uses it. Custom oral appliances (mandibular advancement devices) can be easier to tolerate for some people, but costs, replacement cycles, and follow-up needs differ. This calculator compares the estimated out-of-pocket costs of each option over a chosen time horizon and adjusts the comparison by how often you expect you’ll actually use each therapy.

Important: This tool is for cost/value comparison only. It does not diagnose sleep apnea, predict health outcomes, or determine which treatment is medically appropriate. Treatment selection should be made with a sleep physician and, for oral appliances, a qualified dentist familiar with dental sleep medicine. If you have severe daytime sleepiness, drowsy driving, chest pain, or other urgent symptoms, seek medical care promptly.

What the calculator assumes (and what it does not)

To keep the comparison understandable, the model makes a few simplifying assumptions:

• Perspective: Patient out-of-pocket spending, not total billed charges.
• Insurance coverage input: The “Insurance Coverage (% of device costs)” field is applied to device/appliance purchase costs only (CPAP device and oral appliance). It does not reduce masks, supplies, electricity, or follow-up visits unless you manually lower those inputs to your expected out-of-pocket amounts.
• Compliance meaning: The compliance % is treated as the share of nights used (roughly aligned with common insurer definitions, e.g., usage thresholds). The calculator does not model partial-night use or efficacy differences.
• Time value of money: No inflation, discount rate, or financing costs are included.
• Clinical effectiveness: The tool does not adjust for AHI severity, residual symptoms, or treatment efficacy differences; it only adjusts for usage frequency (nights used).

Inputs, in plain language

Time horizon

Evaluation Horizon (years) sets how long you want to compare ownership and upkeep costs (typically 1–10 years). Longer horizons amplify replacement-cycle differences.

CPAP costs

• CPAP Device Cost: The purchase price you expect to pay (before the insurance % adjustment).
• Mask Cost and Mask Replacement Interval: Used to estimate how many masks you buy per year.
• Filters and Tubing ($/month): Monthly supplies you expect to purchase.
• Electricity ($/month): An estimated monthly electricity cost attributable to CPAP.
• Sleep physician follow-up ($/year): Your expected out-of-pocket cost for follow-ups (copays/coinsurance), not billed amounts.

Oral appliance costs

• Custom Oral Appliance Cost: Fabrication and fitting cost (before the insurance % adjustment).
• Replacement Interval (years): How often you expect replacement due to wear/fit changes.
• Dental follow-up/adjustments ($/year): Typical annual titration/monitoring costs you pay.

Compliance and “value of a restful night”

Compliance (% of nights used) turns calendar nights into effective therapy nights. The optional Estimated Value of a Restful Night ($) lets you attach a personal, non-medical dollar value to a good night of treated sleep (for example, productivity, fewer missed mornings, reduced fatigue-related expenses). If you set this to $0, the calculator becomes a pure cost-per-effective-night comparison.

Formulas used

The calculator estimates total cost over the horizon, then divides by effective nights to get a compliance-adjusted cost metric. In simplified terms:

1) Insurance-adjusted upfront costs

Only device/appliance purchase costs are reduced by the insurance coverage percentage.

2) Replacement counts

CPAP masks are estimated via months/interval. Oral appliance replacements are estimated via years/interval. (Implementations typically round up to ensure partial cycles still count as a replacement within the horizon.)

• Masks per year ≈ 12 / maskIntervalMonths
• Appliance replacements over horizon ≈ years / oralReplacementIntervalYears

3) Total cost over the horizon

Total cost is the sum of insurance-adjusted upfront costs plus recurring costs and replacements:

• CPAP: device + masks + monthly supplies + electricity + physician follow-ups
• Oral appliance: appliance + replacements + dental follow-ups

4) Effective therapy nights

Effective nights are the number of nights in the horizon multiplied by the compliance percentage:

• EffectiveNights = years × 365 × (compliance% / 100)

5) Cost per effective night (compliance-adjusted)

• CostPerEffectiveNight = TotalCost / EffectiveNights

6) Optional “net value” framing

If you provide a value per restful night, you can estimate an informal net value:

• EstimatedBenefit = EffectiveNights × valuePerNight
• NetValue = EstimatedBenefit − TotalCost

This is not a medical claim; it’s a budgeting and preference framework.

How to interpret the results

• Total cost (over the horizon): A budgeting number. Useful if you want to know “What will I likely spend over 5 years?”
• Effective nights: A reality check: two therapies with similar sticker prices can differ substantially if one is used more consistently.
• Cost per effective night: The key comparison metric for many users—lower means you are paying less per night of actual use.
• Net value (if enabled): A personalized financial framing that can highlight how adherence may dominate the comparison. Use cautiously and conservatively.

Worked example (using the default values)

Inputs (defaults): 5 years. CPAP device $900, mask $120 replaced every 6 months, supplies $20/month, electricity $5/month, follow-up $180/year, compliance 65%. Oral appliance $2,200 replaced every 4 years, adjustments $250/year, compliance 82%. Value per restful night $15. Insurance coverage 40% of device costs.

Step 1 — Insurance-adjusted upfront:

• CPAP device out-of-pocket = $900 × (1 − 0.40) = $540
• Oral appliance out-of-pocket = $2,200 × (1 − 0.40) = $1,320

Step 2 — Recurring and replacement estimates (approx.):

• CPAP masks: interval 6 months ⇒ ~2/year ⇒ 10 masks over 5 years ⇒ 10 × $120 = $1,200
• CPAP supplies: $20/month ⇒ $240/year ⇒ 5 years ⇒ $1,200
• CPAP electricity: $5/month ⇒ $60/year ⇒ 5 years ⇒ $300
• CPAP follow-ups: $180/year ⇒ 5 years ⇒ $900
• Oral adjustments: $250/year ⇒ 5 years ⇒ $1,250
• Oral replacements: 5 years with a 4-year interval ⇒ approximately 1 replacement during the horizon (method depends on rounding). If counted, add another $1,320 (insurance-adjusted) replacement cost.

Step 3 — Effective nights:

• CPAP: 5 × 365 × 0.65 ≈ 1,186 nights
• Oral: 5 × 365 × 0.82 ≈ 1,497 nights

Step 4 — Interpret: Even if the oral appliance has higher upfront costs, higher usage can lower the cost per night of actual use for some people. Your own costs and tolerance drive the result, so it’s worth testing a few scenarios (optimistic vs. conservative compliance).

Comparison table: typical cost drivers

Limitations & assumptions (read before acting on results)

• Not medical advice: The calculator cannot determine which therapy is safer or more effective for your OSA severity.
• Compliance is not efficacy: A therapy used frequently is not necessarily equivalently effective across individuals; clinical response matters.
• Insurance rules vary: Coverage may apply to supplies, follow-ups, rentals, replacement schedules, and deductibles differently than modeled here.
• Replacement timing varies: Mask and appliance lifespans depend on wear, cleaning, fit changes, and manufacturer guidance.
• Side effects and ancillary costs: Humidifiers, chin straps, mouth guards, temporomandibular discomfort care, etc., are not explicitly modeled.
• No inflation/discounting: Multi-year costs are treated as nominal dollars.
• 365-night simplification: Leap years, nights away, and intermittent therapy pauses aren’t modeled.

Practical tips

• Run a conservative compliance scenario and an optimistic scenario for each therapy to see how sensitive results are.
• If your insurance covers supplies or follow-ups, enter your expected out-of-pocket amounts in those fields rather than billed totals.
• Bring the outputs (total cost and cost per effective night) to your clinician to support a shared decision—alongside clinical fit, comfort, and treatment response.