Employer-Driven Sleep Apnea Treatment Program Reveals Significant Healthcare Cost Savings

An analysis of a carrier-based mandatory obstructive sleep apnea (OSA) program on truckers’ non—OSA-program medical insurance claim costs revealed substantial healthcare cost savings, according to a study published last week in the journal Sleep.

OSA is associated with specific neurocognitive deficits in attention/working memory, vigilance, and executive functioning, noted the authors. It is among the most common medical causes of excessive daytime sleepiness or fatigue and, if left untreated, is linked to various cardiovascular events such as pulmonary hypertension, type 2 diabetes, and mortality. These potential outcomes from untreated OSA have been shown to cause higher healthcare utilization and costs.

The US Department of Transportation withdrew regulatory process on mandatory screening of truckers for OSA in 2017, with industry cost concerns serving as the chief influence behind the move. Researchers from Precision Pulmonary Diagnostics, Harvard Medical School, Virginia Tech Transportation Institute, and the University of Minnesota-Morris sought to evaluate the effect of an employer-mandated OSA diagnosis and treatment program on truckers’ non—OSA-program medical insurance claim costs to examine whether it generated cost savings.

The joint study derived data from a retrospective cohort analysis constructed by matching screen-positive controls (drivers with insurance screened as likely to have OSA, but not yet diagnosed) with diagnosed drivers (n = 1516; 1224 cases and 292 negative for OSA) on 2 factors affecting exposure to medical claims, which were experience level at hire and weeks of job tenure at the time of the diagnosed driver’s polysomnogram (the matching date). All cases received auto-adjusting positive airway pressure (APAP) treatment and were grouped by objective treatment adherence data that exhibited either positive adherence (n = 932) or no adherence (n = 292).

Bootstrap resampling produced a difference-in-differences estimate of aggregate non—OSA-program medical insurance cost savings for 100 diagnosed drivers compared with 100 screen-positive controls before and after the polysomnogram over 18 months. A 2-part multivariate statistical model was used to set exposures and demographics, and to generate difference-in-differences comparison across periods that identified the effect of OSA treatment on monthly costs per driver, separate from costs related to adherence choice.

Study results exhibited stark medical claim cost savings of $153,042 (95% CI, —$5352 to $330,525) after 18 months from diagnosing and treating 100 screen-positive controls. The analysis additionally showed that for individuals adhering to APAP, a monthly cost reduction of $441 was attributed to each member (95% CI, –$861 to –$21).

In a press release on the study findings, Mark Berger, MD, president and chief executive officer of Precision Pulmonary Diagnostics, highlighted the importance of diagnosing and treating individuals with OSA, as it benefits not only the patient, but the employer as well. “Obstructive sleep apnea continues to be an unrecognized, insidious driver of excessive and avoidable healthcare costs for all employers. Addressing the epidemic magnitude of this condition in society can dramatically reduce employer healthcare costs,” said Berger.

Further savings were generated from reduced driver turnover and improved driver retention. Findings stress the potential of treating OSA through an employer-sponsored program to significantly reduce costs associated with workforce health and safety insurance claims, noted the authors.

Reference

Burks SV, Anderson JE, Panda B, et al. Employer-mandated obstructive sleep apnea treatment and healthcare cost savings among truckers [published online October 24, 2019]. Sleep. doi: 10.1093/sleep/zsz262