Sleep Apnea Treatment Initiation Linked to Reduced Long-Term Health Costs

Perhaps counterintuitive to patient expectation, initiating treatment for obstructive sleep apnea (OSA) is associated with reduced long-term medical spend versus patients with OSA who do not seek care.

In new data presented at the Associated Professional Sleep Societies (SLEEP) 2022 Annual Meeting this week, a team of investigators from artificial intelligence analysis group EnsoData reported that receiving treatment for OSA is associated with reduced overall medical spend in patients—both within 1 year and thereafter.

Investigators, led by EnsoData chief executive officer and co-founder Chris Fernandez, noted that interpretation of OSA therapy cost-effectiveness and benefit to patients’ medical care has been previously difficult to discern. “Research studying the economics of OSA therapy faces confounds including the prevalence of undiagnosed OSA, rate of diagnosed patients declining therapy, spectrum of treatment adherence, and effects of concurrent co-morbidity,” they wrote.

Fernandez and colleagues conducted an actuarial analysis that took into account such confounds to interpret the economic effect of treating OSA. They used a random 5% limited data set of analytical files from the 2016-2018 Medicare claims database representing approximately 2.9 million patients per year. In total, just more than 2 million fee-for-service patients were included in the assessment, with managed care patients and those without complete data excluded.

The study population was stratified into 3 cohorts:

• Patients with OSA receiving treatment for >12 months at baseline
• Patients with OSA receiving treatment for <12 months at baseline
• Patients with OSA who never received treatment

The populations comprised more than 1.35 million patient-months of data. Investigators evaluated healthcare costs in each cohort in the year prior to treatment, at the first of treatment, and a year after treatment.

The cost comparison per month across the 3 treatment arms was adjusted for risk, and investigators conducted a cross-sectional analysis of the results across 7 comorbidities:

• Obesity
• Hypertension
• Type 2 diabetes
• Depression
• COPD
• Congestive heart failure/prior stroke
• Facility versus at-home testing
• Surgical procedures

Mean per-patient, per-month total medical spending was greatest among patients OSA who never treated it, at $1375. Patients with OSA treated for <12 months had a mean monthly cost of $1005 per patient, and patients treating for >12 months had a mean monthly cost of $983.

Among the 2 treatment arms who had initiated care for OSA, mean costs decreased from prior to the year of treated through the post-treatment year. The cohort receiving care for >12 months reported 29% lower health care costs than those not receiving care; the cohort receiving care for <12 months reported 27% lower costs.

Patients with comorbidities in either treatment arm reported similar, yet slighter, differences of health care costs—18% and 16%, respectively. Patients with OSA who underwent surgical procedures had greater costs, but lower reduction in spend at the initial year of therapy (22%) and the year following (5%).

“We observed significant differences in cost between OSA patients that started treatment versus those that did not, and those differences further increased the year following therapy onset,” investigators wrote. “These findings imply that receiving treatment for OSA reduces a patient’s overall medical spend. In terms of mean cost, the >12-month and <12-month cohorts costs fell in both follow-up treatment years.”

The study, “Impact of OSA Therapy on Healthcare Economics: Actuarial Analysis of OSA Prevalence, Therapy Adherence, Co-Morbidity, and Costs in a Large CMS Population Cohort,” was presented at SLEEP 2022.