Association Between Positive Airway Pressure Adherence and Health Care Costs Among Individuals With OSA

Abstract

The impact of positive airway pressure (PAP) therapy for OSA on health care costs is uncertain. Are 3-year health care costs associated with PAP adherence in participants from the Tele-OSA clinical trial? Participants with OSA and prescribed PAP in the Tele-OSA study were stratified into three PAP adherence groups based on usage patterns over 3 years: (1) high (consistently≥ 4 h/night), (2) moderate (2-3.9 h/night or inconsistently≥ 4 h/night), and (3) low (< 2 h/night). Using data from 3months of the Tele-OSA trial and 33months of posttrial follow up, average health care costs (2020 US dollars) in 6-month intervals were derived from electronic health records and analyzed using multivariable generalized linear models. Of 543 participants, 25%were categorized as having high adherence, 22%were categorized as having moderate adherence, and 52%were categorized as having low adherence to PAP therapy. Average PAP use mean ± SD was 6.5 ± 1.0 h, 3.7 ± 1.2 h, and 0.5 ± 0.5h for the high, moderate, and low adherence groups, respectively. The high adherence group had the lowest average covariate-adjusted 6-month health care costs ± SE ($3,207 ± $251) compared with the moderate ($3,638 ± $363) and low ($4,040 ± $304) adherence groups. Significant cost differences were observed between the high and low adherence groups ($832; 95%CI, $127 to $1,538); differences between moderate and low adherence were nonsignificant ($401; 95%CI,-$441 to $1,243). In participants with OSA, better PAP adherence was associated with significantly lower health care costs over 3 years. Findings support the importance of strategies to enhance long-term PAP adherence.