Initiation of sleep apnea treatment linked to reduced long-term health care costs

Perhaps counterintuitive to patient expectations, treatment initiation for obstructive sleep apnea (OSA) is associated with reduced long-term medical expenditure compared to non-seeking OSA patients.

In new data presented this week at the Associated Professional Sleep Societies (SLEEP) 2022 Annual Meeting, a team of researchers from the EnsoData AI Analysis Group reported that receiving treatment for OSA is associated with a reduction in medical spending. overall in patients, both within 1 year and thereafter.

Investigators, led by EnsoData CEO and co-founder Chris Fernandez, noted that the interpretation of the cost-effectiveness of OSA therapy and the benefit to patients’ medical care was previously difficult to discern. “Research studying the economics of OSA therapy faces confounds including the prevalence of undiagnosed OSA, the rate of diagnosed patients who decline therapy, the spectrum of treatment adherence, and the effects of concomitant co-morbidities.” , they wrote.

Fernandez and colleagues conducted an actuarial analysis that took these confusions into account to interpret the economic effect of treating OSA. They used a random dataset limited to 5% of analytics files from the 2016-2018 Medicare Complaints database representing approximately 2.9 million patients annually. In total, just over 2 million paid patients were included in the assessment, excluding patients in managed care and those without complete data.

The study population was stratified into 3 cohorts:

  • Patients with OSA on treatment for> 12 months at baseline
  • Patients with OSA on treatment for <12 months at baseline
  • Patients with OSA who have never received treatment

The populations included more than 1.35 million patient-months of data. Investigators assessed health care costs in each cohort in the year prior to treatment, first treatment, and one year after treatment.

The comparison of monthly costs between the 3 treatment arms was adjusted for risk and the researchers conducted a cross-sectional analysis of the results in 7 comorbidities:

  • Obesity
  • Hypertension
  • Type 2 diabetes
  • Depression
  • COPD
  • Congestive heart failure / previous stroke
  • Structure versus home testing
  • Surgical procedures

Average total medical expenditure per patient and per month was highest among patients with OSA who never treated it, at $ 1375. Patients with OSA treated for <12 mesi avevano un costo medio mensile di $ 1005 per paziente e i pazienti trattati per >12 months had an average monthly cost of $ 983.

Among the 2 treatment arms that initiated treatment for OSA, the mean costs decreased from before the treatment year to the year after treatment. The cohort that received care for more than 12 months reported 29% lower healthcare costs than those who did not receive care; the cohort receiving care for <12 months reported 27% lower costs.

Patients with comorbidities in both treatment arms reported similar, but milder, differences in health care costs of 18% and 16%, respectively. Patients with OSA who underwent surgery had higher costs, but a lower reduction in expenditure in the initial year of therapy (22%) and in the following year (5%).

“We observed significant differences in costs between patients with OSA who started treatment versus those who did not, and those differences increased further the year after starting therapy,” the researchers wrote. “These findings imply that receiving treatment for OSA reduces a patient’s overall medical expense. In terms of average cost, the costs of the cohorts> 12 months and <12 months decreased in both years of follow-up treatment ”.

The study, “Impact of OSA Therapy on Healthcare Economics: Actuarial Analysis of OSA Prevalence, Therapy Adherence, Co-morbidities and Costs in a Large Cohort of the CMS Population”, was presented at SLEEP 2022.

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