Value Networks In Health Care: The Case of Mandibular Advancement Devices in The Treatment of Obstructive Sleep Apnea

Abstract

Obstructive Sleep Apnea (OSA) is a chronic breathing disorder during sleep that is commonly treated with the Continuous Positive Airway Pressure (CPAP). Alternatively, Mandibular Advancement Devices (MAD) can provide an effective therapy. The OSA care path with the decision making actors has been analyzed and the key performance attributes of CPAP and MAD have been determined after 24 in-depth interviews with various care providers and a desk research on 82 sleep clinics in the Netherlands. This information was used to compose a value network, following the approach of Christensen and Rosenbloom (1995). The value network allowed to derive strategic implications that incumbent CPAP firms should consider when entering the OSA treatment market with alternative treatments. Ten distinct actor groups were identified populating the value network. ENTs and pulmonologists were found to be especially important in therapy selection. Main performance attributes of the two treatments were found to be the clinical effectiveness and device comfort, which both have an effect on patient compliance and by that on the ‘true effectiveness’ of the treatment. MAD was found to perform better in terms of device comfort but performs less in clinical effectiveness. Therefore, MAD was not found to have a potential of taking over the severe OSA patients group. The tradeoff between device comfort and clinical effectiveness is better balanced in the mild OSA group. Because the MAD market in The Netherlands is already mature, the moderate OSA patient group is eligible for both treatment options, pinpointing the strategic battlefield of the two treatments. Options of combination-treatments should be investigated, especially for this patient population because synergies are expected to increase patient compliance and by that on the true effectiveness of these combinations. The study has an explorative research design and concepts were developed throughout the research by using small research cycles. It contributed to the research on innovation in health care by applying a new approach of understanding the complex and multi-layered nature of treatment options for obstructive sleep apnea. This study links the value network approach to a care pathway analysis, making the roles of the various actors in clinical decision explicit, revealing the implications of incumbent firms that may want to enter this clinical field. A number of characteristics was identified when using value networks in health care. These include its multi-actor decision making, a-typical supplier-customer dynamics and health insurance regulation that pulls an emerging value network towards the established one.