Abdelwahab Mohamed, Marques Sandro, Huang Allen, De Moraes Thyago P, Previdelli Isolde, Cruz June Alisson Westarb, Al-Sayed Ahmed A, Capasso Robson
Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford University School of Medicine, Stanford, California, USA.
Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
Otolaryngol Head Neck Surg. 2023 May;168(5):1228-1237. doi: 10.1002/ohn.175. Epub 2023 Feb 16.
To determine how surgery, continuous positive airway pressure (CPAP), and no treatment impact health care utilization in patients who have obstructive sleep apnea (OSA).
This is a retrospective cohort study of patients between the ages of 18 and 65 that were diagnosed with OSA (9th International Classification of Diseases) from January 2007 to December 2015. Data were collected over 2 years, and prediction models were generated to evaluate trends over time.
A population-based study using real-world data and insurance databases.
A total of 4,978,649 participants were identified, all with at least 25 months of continuous enrollment. Patients with previous soft tissue procedures not approved for OSA (nasal surgery), or without continuous insurance coverage were excluded. A total of 18,050 patients underwent surgery, 1,054,578 were untreated, and 799,370 received CPAP. IBM Marketscan Research database was utilized to describe patient-specific clinical utilization, and expenditures, across outpatient, and inpatient services, and medication prescriptions.
When the cost of the intervention was eliminated in the 2-year follow-up, the monthly payments of group 1 (surgery) were significantly less than group 3 (CPAP) in overall, inpatient, outpatient, and pharmaceutical payments (p < .001). The surgery group was associated with less cumulative payments compared to the other 2 groups when the cost of the intervention (CPAP or surgery) was eliminated in all comorbidities and age groups.
Treating OSA with surgery can lessen overall health care utilization compared to no treatment and CPAP.
确定手术、持续气道正压通气（CPAP）和不治疗对阻塞性睡眠呼吸暂停（OSA）患者医疗保健利用率的影响。
这是一项对2007年1月至2015年12月期间被诊断为OSA（国际疾病分类第9版）的18至65岁患者进行的回顾性队列研究。数据收集超过2年，并生成预测模型以评估随时间的趋势。
一项基于人群的研究，使用真实世界数据和保险数据库。
共识别出4978649名参与者，均至少连续登记25个月。排除先前未经OSA批准的软组织手术（鼻部手术）患者或无连续保险覆盖的患者。共有18050名患者接受了手术，1054578名未接受治疗，799370名接受了CPAP治疗。利用IBM Marketscan研究数据库描述患者特定的临床利用率以及门诊、住院服务和药物处方的支出。
在2年随访中消除干预成本后，第1组（手术组）在总体、住院、门诊和药物支付方面的月支付显著低于第3组（CPAP组）（p <.001）。在所有合并症和年龄组中消除干预成本（CPAP或手术）后，手术组与其他两组相比累积支付较少。
与不治疗和CPAP相比，手术治疗OSA可降低总体医疗保健利用率。
