• Jaejin An, Henry A Glick, Amy M Sawyer, Jessica Arguelles, Charles J Bae, Brendan T Keenan, Samuel T Kuna, Greg Maislin, Diego R Mazzotti, Allan I Pack, Jiaxiao M Shi, Alexa J Watach, and Dennis Hwang.
• Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
• Chest. 2023 Jun 1; 163 (6): 154315541543-1554.

BackgroundThe impact of positive airway pressure (PAP) therapy for OSA on health care costs is uncertain.Research QuestionAre 3-year health care costs associated with PAP adherence in participants from the Tele-OSA clinical trial?Study Design And MethodsParticipants with OSA and prescribed PAP in the Tele-OSA study were stratified into three PAP adherence groups based on usage patterns over 3 years: (1) high (consistently ≥ 4 h/night), (2) moderate (2-3.9 h/night or inconsistently ≥ 4 h/night), and (3) low (< 2 h/night). Using data from 3 months of the Tele-OSA trial and 33 months of posttrial follow up, average health care costs (2020 US dollars) in 6-month intervals were derived from electronic health records and analyzed using multivariable generalized linear models.ResultsOf 543 participants, 25% were categorized as having high adherence, 22% were categorized as having moderate adherence, and 52% were categorized as having low adherence to PAP therapy. Average PAP use mean ± SD was 6.5 ± 1.0 h, 3.7 ± 1.2 h, and 0.5 ± 0.5 h for the high, moderate, and low adherence groups, respectively. The high adherence group had the lowest average covariate-adjusted 6-month health care costs ± SE ($3,207 ± $251) compared with the moderate ($3,638 ± $363) and low ($4,040 ± $304) adherence groups. Significant cost differences were observed between the high and low adherence groups ($832; 95% CI, $127 to $1,538); differences between moderate and low adherence were nonsignificant ($401; 95% CI, -$441 to $1,243).InterpretationIn participants with OSA, better PAP adherence was associated with significantly lower health care costs over 3 years. Findings support the importance of strategies to enhance long-term PAP adherence.Copyright © 2023 American College of Chest Physicians. All rights reserved.

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