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Association between adherence to continuous positive airway pressure treatment and cost among medicare enrollees.
Chhatre, Sumedha; Chang, Yoon Hee A; Gooneratne, Nalaka S; Kuna, Sam; Strollo, Patrick; Jayadevappa, Ravishankar.
Afiliação
  • Chhatre S; Department of Psychiatry, University of Pennsylvania, Philadelphia, PA.
  • Chang YHA; Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA.
  • Gooneratne NS; Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA.
  • Kuna S; Division of Geriatric Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA.
  • Strollo P; Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA.
  • Jayadevappa R; Corporal Michael J. Crescenz VAMC, Philadelphia, PA.
Sleep ; 43(1)2020 01 13.
Article em En | MEDLINE | ID: mdl-31403696
OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Medicare / Apneia Obstrutiva do Sono / Pressão Positiva Contínua nas Vias Aéreas Tipo de estudo: Etiology_studies / Health_economic_evaluation / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male País/Região como assunto: America do norte Idioma: En Revista: Sleep Ano de publicação: 2020 Tipo de documento: Article País de publicação: Estados Unidos
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Medicare / Apneia Obstrutiva do Sono / Pressão Positiva Contínua nas Vias Aéreas Tipo de estudo: Etiology_studies / Health_economic_evaluation / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male País/Região como assunto: America do norte Idioma: En Revista: Sleep Ano de publicação: 2020 Tipo de documento: Article País de publicação: Estados Unidos