TY  - JOUR
PY  - 2019//
TI  - Employer-mandated obstructive sleep apnea treatment and healthcare cost savings among truckers
JO  - Sleep
A1  - Burks, Stephen V.
A1  - Anderson, Jon E.
A1  - Panda, Bibhudutta
A1  - Haider, Rebecca
A1  - Ginader, Tim
A1  - Sandback, Nicole
A1  - Pokutnaya, Darya
A1  - Toso, Derek
A1  - Hughes, Natalie
A1  - Haider, Humza S.
A1  - Brockman, Resa
A1  - Toll, Alice
A1  - Solberg, Nicholas
A1  - Eklund, Jesse
A1  - Cagle, Michael
A1  - Hickman, Jeffery S.
A1  - Mabry, Erin
A1  - Berger, Mark
A1  - Czeisler, Charles A.
A1  - Kales, Stefanos N.
SP  - ePub
EP  - ePub
VL  - ePub
IS  - ePub
N2  - 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. <br><br>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. <br><br>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). <br><br>CONCLUSIONS: Results suggest a carrier-based mandatory OSA program generates substantial savings in non-OSA-program medical insurance claim costs.<br><br>© 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.<p />  <p>Language: en</p>
LA  - en
SN  - 0161-8105
UR  - http://dx.doi.org/10.1093/sleep/zsz262
ID  - ref1
ER  -