HEALTHCARE UTILIZATION IN INITIATION OF ORAL APPLIANCE VS POSITIVE AIRWAY PRESSURE THERAPY FOR SLEEP APNEA

Abstract Introduction The COVID-19 pandemic and related supply chain issues have created shortages in integral components of Positive Airway Pressure (PAP) devices, the gold standard treatment for sleep apnea. Concurrently, patients have delayed care and are returning in increasing numbers. With these overlapping pressures, alternative treatments are needed. Custom-fabricated Oral Appliances (OA) are uniquely poised as a solution. However, it is unknown if initiation and treatment cost and healthcare utilization are similar to PAP or will create further disruptions at scale. Methods Patients who initiated PAP or OA therapy 2018-2020 were included. Matched visits 2017-2021 were referenced. Patients with multiple treatment initiations were excluded. Healthcare utilization quantified number visits, stratified by provider type (Physician, Physician Assistant (PA), American Board of Dental Sleep Medicine (ABDSM) Accredited Dentist, or Registered Polysomnographic Technologist (RPSGT)). Contractual amounts for CPT codes were averaged to estimate cost. Results 5172 patients, 374 received OA (7.2%). Prior to initiation, OA therapy utilized more visits on average than PAP (4.5±1.7(±SD) vs 3.5±1.9, p<0.0001). Following initiation, OA therapy utilized fewer visits than PAP (4.1±3.9 vs 5.5±4.6, p<0.0001). Specialized provider visits, i.e. dentist for OA, were lower compared to RPSGT for PAP therapy, both before and after initiation (1.4±0.8 vs 2.0±1.4 before, 1.9±1.2 vs 2.6±1.8 after, both p<0.0001). Further, prior to initiation, Physician and PA utilization was similar between OA and PAP therapies (1.4±0.8 vs 1.5±1.0 Physician, 1.1±0.8 vs 1.2±0.8 PA, both p>0.057). However, following initiation, OA therapy utilized fewer Physician visits than PAP (1.7±1.1 vs 2.1±1.7, p<0.0001) but similar PA visits (1.9±1.5 vs 2.1±1.4, p>0.5). Together, with OA dental visits estimated to be the least expensive associated visit, this analysis estimates that the provider cost of initiation of OA therapy is lower than that of PAP. Conclusion Overall, OA therapy requires less healthcare utilization, especially of providers with highest reimbursement rates. While OA requires more initial appointments, PAP therapy requires more follow up visits with specialized providers and physicians, thereby increasing cost for patients. Additional cost burden of these visits could impact patient willingness to initiate treatment. This analysis provides supportive evidence for OA as an alternative to PAP with lower treatment cost and healthcare utilization, which may provide an advantage for the already over-burdened healthcare system. Support (If Any)