Financial incentive of home continuous positive airway pressure machine use in the inpatient hospital setting

Abstract

Obstructive sleep apnea (OSA) is increasingly recognized as a significant factor in perioperative and inpatient health. Because of this, hospitalized OSA patients are encouraged to utilize continuous positive airway pressure (CPAP) therapy while inpatients. We investigated the cost difference of patient-owned versus hospital-provided CPAP machine use by admitted adult patients with OSA. Prospective cohort study at a tertiary academic center. All new-patient admissions >18 years of age who were prescribed CPAP while inpatients over a 2-month period were included. Demographic information was collected, and cost analysis was performed. CPAP was used for 162 (1.2%) admissions. Mean patient age was 59 ± 13 years; the majority were white (56.8%) and male (64.2%). Average CPAP utilization was 5.3 ± 5.5 nights. The differential cost per day for patients using hospital-provided CPAP was $416.10 more than for patients using home CPAP machines. This cost included direct costs of an extended respiratory therapy (RT) initial visit, machine rental fee ($27.50), and additional RT evaluation time (mean, 85-145 relative value units). The base initial visit was the same for all patients. Over the 2-month study period, the total cost difference in charges was $195,912; this extrapolates to $1,175,471 yearly. This is the first study to characterize the magnitude of cost savings from utilization of home versus hospital-provided CPAP machines in patients requiring inpatient CPAP machine use. The use of patient-owned CPAP machines may reflect an opportunity to provide cheaper care while maintaining high patient safety and quality care. The actual economic impact to an individual hospital would vary based on the insurance payer mix.