PAP Therapy Adherence and Reduced Health Care Resource Use and Costs

Adherence to positive airway pressure (PAP) therapy in patients with obstructive sleep apnea (OSA) and atrial fibrillation (AF) is associated with significantly decreased emergency department visits and associated health care costs, investigators reported in the Journal of the American Heart Association.

The retrospective, observational study used deidentified payer-sourced administrative medical and pharmacy claims data from more than 100 US commercial, Medicare Advantage, and Medicaid health plans linked with patient PAP use data.

Eligible participants were newly diagnosed with OSA within 60 days of a sleep test, received PAP therapy using an AirSense 10 device, and had 1 or more years of claims data before sleep test and 2 years of claims data after device setup. Device setup occurred from October 1, 2016, to April 27, 2018.

Outcomes included the number of all-cause hospitalizations, emergency department and physician visits, and costs during the first and second years after PAP initiation. The primary predictor was long-term adherence to PAP therapy, which was objectively defined from device data.

The analysis included 5867 patients (mean age, 62.7 years; 32% women), of whom 41% were adherent, 38% were intermediately adherent, and 21% were nonadherent. After inverse probability of treatment weighting (IPTW), the 3 adherence groups had similar baseline characteristics, including previous year health care resource use (HCRU; absolute value of all standardized mean differences [SMDs], <0.1).

In the first year of PAP use, the mean number of all-cause emergency department visits was significantly reduced in the adherent group (0.61, [SD, 1.21]) vs the intermediate group (0.77 [SD, 1.55]; P =.023) and nonadherent group (0.95 [SD, 1.90]; P <.001), as well as annual all-cause hospitalizations (0.19 [SD, 0.69] vs 0.24 [SD, 0.72]; P =.002 vs 0.34 [SD, 1.16]; P <.001, respectively). This represented a 36% lower rate of all-cause emergency department visits (rate ratio [RR], 0.64; 95% CI, 0.59-0.69) and a 44% reduced rate for all-cause hospitalization (RR, 0.56; 95% CI, 0.49-0.64) for adherent patients compared with nonadherent patients in the first year.

Adherent patients also had fewer cardiac-related emergency department visits compared with nonadherent patients (0.11 [SD, 0.41] vs 0.14 [SD, 0.52]; P =.057) and significantly fewer cardiac-related hospitalizations (0.06 [SD, 0.26] vs 0.10 [SD, 0.44]; P =.004).

Adherent patients had significantly reduced all-cause inpatient costs ($2200 [SD, $8054]) vs intermediate patients ($3274 [SD, $12,065]; P =.002) and nonadherent patients ($4483 [SD, $16,499]; P <.001). Adherent patients also had significantly reduced all-cause emergency department costs compared with nonadherent patients ($499 [SD, $1229] vs $691 [SD, $1652]; P <.001). Individuals who had intermediate adherence had significantly reduced emergency department costs vs nonadherent patients ($563 [SD, $1292]; P =.002).

Similar results were observed in the second year of PAP use, with adherent patients having significantly fewer all-cause hospitalizations compared with nonadherent patients (RR, 0.73; 95% CI, 0.63-0.84). Adherent patients also had significantly fewer all-cause emergency department visits vs intermediate and nonadherent patients. In addition, adherent patients had significantly lower all-cause inpatient hospitalization costs and all-cause emergency department costs compared with nonadherent patients in the second year.

Limitations include the retrospective design, and the researchers were unable to account for patient factors such as healthy habits, laboratory test results, socioeconomic status, and patient-reported outcomes and motivations. In addition, none of the participants had Medicare fee for service.

“These findings highlight the importance of diagnosing and treating OSA in patients with AF,” the investigators wrote.

Disclosure: The research was funded by ResMed. Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

This article originally appeared on The Cardiology Advisor