Association Between Positive Airway Pressure Adherence And Healthcare Costs

Background The impact of positive airway pressure (PAP) therapy for obstructive sleep apnea (OSA) on healthcare costs is uncertain. Research Question Are three-year healthcare costs associated with PAP adherence in participants from the Tele-OSA clinical trial? Study Design and Methods Participants with OSA and prescribed PAP in the Tele-OSA study were stratified into three PAP adherence groups based on usage patterns over three years: (a) high (consistently ≥ 4 hours/night); (b) moderate (2-3.9 hours/night or inconsistently ≥ 4 hours/night); (c) low (<2 hours/night). Using data from three months of the Tele-OSA trial and 33 months of post-trial follow-up, average healthcare costs (2020 US dollars) in six-month intervals were derived from electronic health records and analyzed using multivariable generalized linear models. Results Of 543 participants, 25% were categorized as having high adherence, 22% moderate adherence, and 52% low adherence to PAP therapy. Average (standard deviation) PAP use was 6.5 (1.0) hours, 3.7 (1.2) hours, and 0.5 (0.5) hours for the high, moderate, and low adherence groups, respectively. The high adherence group had the lowest average [standard error] covariate-adjusted six-month healthcare costs ($3,162 [$240]) compared with the moderate ($3,658 [$369]) and low ($4,016 [$315]) adherence groups. Significant cost savings were observed between the high and low adherence groups ($854 [95% CI $158, $1,551]); savings between moderate and low adherence were non-significant ($359 [95% CI -$459, $1,176]). Interpretation In participants with OSA, better PAP adherence was associated with significantly lower healthcare costs over three years. Findings support the importance of strategies to enhance long-term PAP adherence. ### Competing Interest Statement An, Glick, Bae: No conflicts to disclose Sawyer: Research funding from National Institutes of Health and Veterans Affairs HSR&D. Mazzotti: Research funding from AASM Foundation, American Heart Association and National Institutes of Health. Hwang: Research funding from AASM Foundation, National Institutes of Health, and Kaiser Permanente Southern California Research and Evaluation Clinical Investigator Program. Watach: Research training supported by National Institutes of Health. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government. ### Funding Statement No funding was provided for this research. The Tele-OSA Study was originally supported by funding from the American Sleep Medicine Foundation Strategic Research Award 104-SR-13 and equipment support from ResMed Corp. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Tele-OSA study and all subsequent analyses based on the study cohort were approved by the Kaiser Permanente Southern California Institutional Review Board. Participant written informed consent was waived for the entire study, including the epidemiologic follow-up, due to the minimal risk of the study interventions and data collection procedures. All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes Anonymized data that support the findings of this study may be made available from the investigative team with the following conditions: 1) agreement to collaborate with the study team on all publications, 2) provision of external funding for administrative and investigator time necessary for this collaboration, 3) demonstration that the external investigative team is qualified and has documented evidence of training for human subjects protections, and 4) agreement to abide by the terms outlined in data use agreements between institutions. * AHI : Apnea Hypopnea Index ANOVA : analysis of variance BMI : body mass index CPT : Current Procedural Terminology DME : durable medical equipment GLM : generalized linear models HCPCS : Healthcare Common Procedure Coding System NADAC : National Average Drug Acquisition Cost OSA : Obstructive sleep apnea PAP : positive airway pressure