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Citation
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Burks SV, Anderson JE, Panda B, Haider R, Ginader T, Sandback N, Pokutnaya D, Toso D, Hughes N, Haider HS, Brockman R, Toll A, Solberg N, Eklund J, Cagle M, Hickman JS, Mabry E, Berger M, Czeisler CA, Kales SN. Sleep 2019; ePub(ePub): ePub. |
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Affiliation
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Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA. |
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Abstract
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OBJECTIVE: To evaluate the effect of an employer-mandated obstructive sleep apnea (OSA) diagnosis and treatment program on non-OSA-program trucker medical insurance claim costs.
METHODS: Retrospective cohort analysis; cohorts constructed by matching (randomly, with replacement) Screen-positive Controls (drivers with insurance screened as likely to have OSA, but not yet diagnosed) with Diagnosed drivers (n=1,516; cases=1,224, OSA Negatives=292), on two factors affecting exposure to medical claims: experience level at hire and weeks of job tenure at the Diagnosed driver's polysomnogram (PSG) date (the "matching date"). All cases received auto-adjusting positive airway pressure (APAP) treatment, and were grouped by objective treatment adherence data: any "Positive Adherence" (n=932) versus "No Adherence" (n=292). Bootstrap resampling produced a difference-in-differences estimate of aggregate non-OSA-program medical insurance claim cost savings for 100 Diagnosed drivers as compared to 100 Screen-positive Controls before and after the PSG/matching date, over an eighteen-month period. A two-part multivariate statistical model was used to set exposures and demographics/-anthropometrics equal across sub-groups, and to generate a difference-in-differences comparison across periods that identified the effect of OSA treatment on per-member per-month costs of an individual driver, separately from cost differences associated with adherence choice.
RESULTS: Eighteen-month non-OSA-program medical claim costs savings from diagnosing (and treating as required) 100 Screen-positive Controls: $153,042 (95% CI: -$5,352, $330,525). Model-estimated effect of treatment on those adhering to APAP: -$441 per-member per-month (95% CI: -$861, -$21).
CONCLUSIONS: Results suggest a carrier-based mandatory OSA program generates substantial savings in non-OSA-program medical insurance claim costs.
© Sleep Research Society 2019. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.
Language: en |