Association Between Positive Airway Pressure Therapy and Healthcare Costs Among Older Adults with Comorbid Obstructive Sleep Apnea and Common Chronic Conditions: An Actuarial Analysis.

Study objectives: To determine the association between adherence to positive airway pressure and healthcare costs among a national sample of older adults with comorbid OSA and common chronic conditions.

Methods: Our data source was a random sample of Medicare administrative claims for years 2016-2019. Inclusion criteria included age >65 years and new diagnosis of OSA. Exclusion criteria included evidence of prior OSA treatment during the 12 months prior to the index date, active cancer, or end-stage renal disease. OSA was defined using physician-assigned diagnostic codes. Common chronic conditions included chronic obstructive pulmonary disease, congestive heart failure, depression, hypertension, type 2 diabetes mellitus, obesity, and stroke. Based on Medicare policy, individuals were classified as adherers, non-adherers, or non-initiators. Risk adjustment was based on the CMS-HCC approach developed by the Centers for Medicaid and Medicare Service specifically to estimate anticipated costs. To examine the impact of PAP adherence on costs, we employed a weighted DID regression framework to account for baseline variations in health status and other confounding factors.

Results: Participants included 28,220 Medicare beneficiaries with comorbid OSA. Of these, 45% were adherent to PAP, 10% were non-adherent, and 44% did not initiate PAP. Relative to non-initiators, beneficiaries who initiated PAP displayed $195 reduced per-member per-month costs over 24 months. This finding remained consistent across all seven medical and psychiatric subgroups, as well as among individuals with multimorbidity.

Conclusions: In this national analysis of Medicare beneficiaries with common chronic conditions, PAP adherence was associated with reduced costs over 24 months.