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.