Abstract and Introduction
Abstract
Purpose of review Obstructive sleep apnea (OSA) has a substantial economic impact on healthcare systems. We reviewed parameters affecting healthcare costs (race, low education, and socioeconomic status) on OSA comorbidity, and costs and the effect of OSA treatment on medical costs.
Recent findings OSA is associated with increased cardiovascular disease (CVD) morbidity and substantially increased medical costs. Risk for OSA and resulting CVD are associated with obesity, tobacco smoking, black race, and low socioeconomic status; all these are associated with poor continuous positive airway pressure (CPAP) adherence. Healthcare costs are not normally distributed, that is, the costliest and the sickest upper third of patients consume 65–82% of all medical costs. Only a limited number of studies have explored the effect of CPAP on medical costs.
Summary Costs of untreated OSA may double the medical expenses mainly because of CVD. Identifying the costliest, sickest upper third of OSA patients will reduce expenses to healthcare systems. Studies exploring the effect of CPAP on medical costs are essential. In addition, tailoring intervention programs to reduce barriers to adherence have the potential to improve CPAP treatment, specially in at-risk populations that are sicker and consume more healthcare costs.
Introduction
Health authorities of many countries encourage economic evaluations and public health studies to better understand the utility of diagnosing and treating obstructive sleep apnea (OSA).[1–7] OSA can lead to excessive daytime sleepiness, impairment of quality of life, and considerable morbidity from cardiovascular disease (CVD).[8–12] Population-based studies estimate the prevalence of clinically significant OSA to be approximately 3–7% for adult males and 2–5% for adult females in the general population.[13–15] Risks for OSA are associated with obesity, poor education, lower income, and residence in rural areas. The prevalence of OSA among obese patients exceeds 30%, reaching as high as 50–98% in the morbidly obese population.[16] Despite growing knowledge of OSA most patients are undiagnosed. We demonstrated that at the level of primary care, physicians are limited in their ability to recognize the presence of OSA.[17] Although many physicians understand the algorithms for the diagnosis of OSA, the majority could not identify the patients for whom diagnostics were needed. A recent study conducted within Union Pacific Railroad Employees Health Systems found that a focused educational campaign on sleep-disordered breathing improved health outcomes and led to measurable reduction of medical expenses.[18] As physicians and the general population gain more awareness of OSA, there has been a steadily increasing demand to identify individuals who are suspected of having this disorder. However, access to diagnostic services for OSA has become a major obstacle, because of the relative lack of sleep laboratories as well as sleep specialists. The increased use of home-based tests rather than laboratory-based diagnostic testing and treatment titration increases considerably the availability of OSA diagnosis and treatment;[19,20] however, some consider this approach controversial.[4,21] The use of home-based tests can increase access to diagnosis and treatment of OSA. However, these devices must be used as part of a comprehensive sleep evaluation program that includes access to board-certified sleep specialists, polysomnography facilities, and experienced professionals.
Curr Opin Pulm Med. 2013;19(6):639-644. © 2013 Lippincott Williams & Wilkins
