0927 The Evolution of Costs for Telehealth versus In-person PAP Initiation for Patients with Sleep Apnea over the COVID Pandemic

Abstract

Abstract Introduction During the COVID pandemic, at the San Francisco VA Healthcare System (VASFHS), positive airway pressure (PAP) set-up visits transitioned from in person to a mix of in person and telehealth for patients newly diagnosed sleep apnea. As part of a larger study examining the clinical outcomes resulting from telehealth versus in-person PAP initiation, we performed a cost analysis of these two treatment pathways within VASFHS. Methods The telehealth pathway included mailing of PAP machines to patients (initially from VASFHS and later through a centralized national distributor), with follow-up video/phone education by respiratory therapists (RTs) and registered sleep technicians (RSTs). We used a bottom-up analysis to examine the total variable direct cost of telehealth versus in-person PAP initiation at various points through the COVID pandemic for patients newly diagnosed with sleep apnea at VASFHS. Results The total variable direct cost of telehealth PAP initiation was $49.66 per patient mid-pandemic (Feb-Dec 2020) compared to $31.02 per patient post-pandemic (Oct-Dec 2022). The total variable direct cost of in-person PAP initiation was $16.76 per patient pre-pandemic (Jan-Dec 2019) compared to $22.71 per patient post-pandemic. The reduction in costs (37.5%) for telehealth PAP initiation mid- to post-pandemic was due to 25% less RT/RST time required and elimination of PAP shipping costs as PAP distribution became nationally centralized. The increase in costs (35.5%) for in-person PAP initiation pre- to post-pandemic was largely due to elimination of group PAP initiation sessions (33.3% more RT/RST time required for individual PAP initiation). Post-pandemic, telehealth PAP initiation cost was 36.6% more than in-person due to 25% more RT/RST time required and five times as much troubleshooting help required for the telehealth pathway. Conclusion With integration of telehealth for PAP initiation, as RT/RSTs gained more expertise with this interface through the pandemic and as distribution of PAP machines/supplies became centralized, costs were significantly reduced, making telehealth a financially sustainable workflow. Future cost analysis can evaluate if group rather than individual telehealth PAP initiation would yield additional cost savings, placing it on par with the cost of in-person PAP initiation. Support (if any) VA OCC FY21 RFA, VAGLAHS GRECC, K24HL143055