Employer-mandated obstructive sleep apnea treatment and healthcare cost savings among truckers
| Autor: | Charles A. Czeisler, Jeffery S. Hickman, Erin Mabry, Resa Brockman, Mark Berger, Stefanos N. Kales, Derek Toso, Alice Toll, Humza S. Haider, Jesse Eklund, Michael Cagle, Bibhudutta Panda, Rebecca Haider, Natalie Hughes, Nicole Sandback, Nicholas Solberg, Tim Ginader, Darya Y. Pokutnaya, Stephen V. Burks, Jon E. Anderson |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Matching (statistics) Polysomnography Poison control Occupational safety and health 03 medical and health sciences 0302 clinical medicine Cost Savings Physiology (medical) Injury prevention Positive airway pressure Humans Medicine 030212 general & internal medicine health care economics and organizations Retrospective Studies Sleep Apnea Obstructive Continuous Positive Airway Pressure business.industry Retrospective cohort study Health Care Costs Anthropometry medicine.disease respiratory tract diseases Obstructive sleep apnea Emergency medicine Neurology (clinical) Sleep Disordered Breathing business 030217 neurology & neurosurgery |
| Zdroj: | Sleep |
| ISSN: | 1550-9109 0161-8105 |
| DOI: | 10.1093/sleep/zsz262 |
| Popis: | 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 18-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 (PMPM) 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 PMPM (95% CI: −$861, −$21). Conclusions Results suggest a carrier-based mandatory OSA program generates substantial savings in non-OSA-program medical insurance claim costs. |
| Databáze: | OpenAIRE |
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