Performance of Claims-Based Algorithms for Adherence to Positive Airway Pressure Therapy in Commercially Insured Patients With OSA

Abstract

BackgroundPositive airway pressure (PAP) therapy is first line therapy for obstructive sleep apnea (OSA), but consistent use is required for it to be effective. Previous studies have used Medicare fee-for-service claims data (e.g., device and equipment charges) as a proxy for PAP adherence to assess its effects. However, this approach has not been validated in a United States (US) commercially insured population, where coverage rules are not standardized. Research QuestionIn a commercially insured population in the US, how well do claims-based algorithms for defining PAP adherence correspond with objective PAP device usage? Study Design and MethodsDe-identified administrative claims data of commercially insured patients (18-64 years) with OSA were linked to objective PAP therapy usage data from cloud-connected devices. Adherence was defined based on device use (using an extension of Centers for Medicare and Medicaid Services 90-day compliance criteria) and from claims-based algorithms to compare usage metrics and identify potential misclassifications. ResultsThe final sample included 213,341 patients. Based on device usage, 48% were adherent in the first year. Based on claims, between 10 and 84% of patients were identified as adherent (accuracy, sensitivity, specificity ranges: 53-68%, 12-95%, 26-92%, respectively). Relative to claims-adherent patients, device-adherent patients had consistently higher usage across all metrics (mean: 339.9 vs. 260.0-290.0 days of use; 6.6 vs. 5.1-5.6 days per week; 6.4 vs. 4.6-5.2 hours per day). Consistent PAP users were frequently identified by claims-based algorithms as non-adherent, while many inconsistent users were classified by claims-based algorithms as adherent. InterpretationIn aggregate US commercial data with non-standardized PAP coverage rules, concordance between existing claims-based definitions and objective PAP use was low. Caution is warranted when applying existing claims-based algorithms to commercial populations. Clinical Trials Registration NumberNot applicable