Association of Positive Airway Pressure Use With Acute Care Utilization and Costs

Abstract

Study Objectives: The current value-based medical climate has led to scrutiny of all medical costs. Given the relationship between obstructive sleep apnea (OSA) and many significant comorbid medical conditions, treating patients with OSA via positive airway pressure (PAP) therapy might reduce health care expenditures. Our goal was to determine the relationship between PAP use and acute care utilization and costs. Methods: This was a retrospective cohort study of adult patients who initiated PAP therapy after a diagnosis of moderate-severe OSA at a large integrated health system during 2014-2016. Results: The study consisted of 1,098 patients, of which 60% were on PAP > 4 h/night for ≥ 70% of the nights. The average h/night were 5.3 (standard deviation 2.4). Increasing PAP usage was associated with reduced inpatient (rate ratio [RR] 0.92, 95% confidence interval [CI] 0.86-0.98) and overall acute care visits (RR 0.96, 95% CI 0.92-0.99). The linear relationships were supported by the threshold effects identified in the categorical adherence measures. No linear association was identified with emergency department visits and inpatient stays. However, lower number of emergency department visits (RR 0.78, 95% CI 0.62-0.98) and inpatient stays (RR 0.56, 95% CI 0.35-0.91) were observed among adherent (> 4 h/night for ≥ 70% of the nights) patients. Conclusions: PAP usage was linearly associated with reduced number of inpatient and overall acute care visits, and lower likelihood of having positive costs from these visits. PAP usage was also associated with less emergency department visits and inpatient stays when comparing adherent patients to less adherent patients.

Association between Positive Airway Pressure Adherence and Healthcare Costs

“…A recent study by Kirsch et al . reported that use of PAP at least 4 hours/night over an 18-month period in participants with moderate-severe OSA was associated with lower inpatient visits and costs compared with non-adherers [44]. Our study adds to the body of evidence that long-term adherence to PAP therapy can beneficially impact healthcare costs.…”

“…The increase in health-related costs is reflected in a broad spectrum of services affecting inpatient, outpatient, emergency, and pharmacy-related costs [34, 43-45]. Conceptually, positive airway pressure (PAP) therapy should mitigate the impact of OSA on healthcare utilization; however, the overall body of evidence is limited and its results are mixed [34, 44-47]. Furthermore, recent technological advances in PAP devices have resulted in the ability to remotely monitor objective measures of PAP adherence over time.…”

Value-based sleep and breathing: health economic aspects of obstructive sleep apnea

“…Since that time, two additional studies have found a beneficial effect on PAP. Kirsch and colleagues 27 analyzed data from a large health system in the Southeastern US. These investigators found a linear dose-response relationship between objective CPAP adherence data and acute healthcare costs, including reductions in inpatient stays and acute care visits.…”

Obstructive sleep apnea screening, diagnosis, and treatment in the transportation industry

“…17 These include improved daytime alertness, 23 improved blood pressure control [24][25][26] (particularly in those with resistant hypertension 24 ), possibly reduced insulin resistance and improved glycemic control in diabetic patients, 27,28 improved quality of life, 23,29 reduced rates of drowsiness-related crashes, 12,[30][31][32] and lower risk of both cognitive deficits and cardiovascular disease. 23,33,34 In the workplace, lower health care costs [35][36][37] and rates of disability, 38 reduced absenteeism and occupational incidents, and improved productivity have been associated with PAP use. 39 PAP therapy also has been shown to improve all-cause mortality.…”