Department of Psychiatry, University of Pennsylvania, Philadelphia, PA.
Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA.
Sleep. 2020 Jan 13;43(1). doi: 10.1093/sleep/zsz188.
To analyze the cost associated with sleep apnea and effects of continuous positive airway pressure (CPAP) treatment on costs among fee-for-service Medicare beneficiaries.
Retrospective cohort design using 5% Medicare claims between 2006 and 2010. Medicare beneficiaries with and without sleep apnea diagnosis between 2007 and 2008 were identified and followed retrospectively for 2 years pre-index-date and 2 years post-index-date. We defined CPAP fill as at least one durable medical equipment claim for CPAP in 6-month period. At least three CPAP fills was defined as "full adherence," and one or two CPAP fills was "partial adherence." We used interrupted time series and generalized linear log-link models to study the association between sleep apnea, CPAP treatment, and costs. To minimize bias, we used propensity score and instrumental variables approach.
Sleep apnea was associated with higher costs (odds ratio [OR] = 1.60; 95% confidence interval [CI] = 1.58, 1.63) compared to those without sleep apnea. Almost half of those with sleep apnea received CPAP treatment. Interrupted time series analysis indicated post level increase in mean monthly cost for full CPAP adherence group, partial CPAP adherence group and no-CPAP group. However, the increase was smallest for the full CPAP adherence group. Full CPAP adherence was associated with lower change in cost (OR = 0.92; 95% CI = 0.88, 0.97) compared to the no-CPAP group.
Medicare beneficiaries with sleep apnea experience increased cost. Full adherence to CPAP treatment for sleep apnea was associated with lower increase in cost. These findings emphasize the need to effectively identify and treat sleep apnea in Medicare patients.
分析睡眠呼吸暂停相关成本，以及持续气道正压通气（CPAP）治疗对医疗保险受益人的成本的影响。
采用 2006 年至 2010 年 5%的医疗保险索赔数据进行回顾性队列设计。在 2007 年至 2008 年期间，确定患有和未患有睡眠呼吸暂停的医疗保险受益人的诊断，并对其进行回顾性随访，随访时间为索引日期前 2 年和索引日期后 2 年。我们将 CPAP 填充定义为在 6 个月内至少有一项耐用医疗设备的 CPAP 索赔。至少三次 CPAP 填充被定义为“完全依从”，一次或两次 CPAP 填充被定义为“部分依从”。我们使用中断时间序列和广义线性对数链接模型来研究睡眠呼吸暂停、CPAP 治疗和成本之间的关系。为了最大限度地减少偏差，我们使用倾向评分和工具变量方法。
与未患有睡眠呼吸暂停的人相比，患有睡眠呼吸暂停的人成本更高（比值比 [OR] = 1.60；95%置信区间 [CI] = 1.58，1.63）。近一半的睡眠呼吸暂停患者接受了 CPAP 治疗。中断时间序列分析表明，完全 CPAP 依从组、部分 CPAP 依从组和无 CPAP 组的平均每月费用呈上升趋势。然而，完全 CPAP 依从组的增幅最小。与无 CPAP 组相比，完全 CPAP 依从组的成本变化较低（OR = 0.92；95%CI = 0.88，0.97）。
患有睡眠呼吸暂停的医疗保险受益人会经历成本增加。对睡眠呼吸暂停的 CPAP 治疗完全依从与成本增加的降低有关。这些发现强调了在医疗保险患者中有效识别和治疗睡眠呼吸暂停的必要性。
