1178 PAP THERAPY AND HEALTH CARE UTILIZATION

Abstract Introduction: We sought to determine if treatment for sleep apnea with positive airway pressure (PAP) therapy was associated with reduced healthcare utilization in a large, integrated health system. Methods: Electronic health records were used to identify participants with sleep apnea and PAP therapy (cases) and those without either (non-cases). Acute care hospital days and dispensed medications supply were compared among cases and non-cases. Negative binomial regression was used to estimate utilization with 95% confidence interval (CI) for five years before to seven years after PAP dispensation or a randomly selected index date in non-cases. Adjustment was made for time-varying comorbidities and mortality after the index date. Analyses were repeated using a propensity score matched cohorts drawn from cases and non-cases. Results: There were 50,179 patients with sleep apnea and PAP and 249,995 randomly selected non-cases; ta subgroup of 13,271 cases were propensity score matched to an equal number of non-cases. Cases had greater acute care and less medication utilization before the start of PAP compared to non-cases. We observed a 6.2% decline in acute care utilization following PAP dispensation (from 1.077 to 1.011 events/person-year, P&lt0.05). A non-significant 3.1% increase in medication utilization was observed (from 0.999 to 1.031 medications per day/person-year). Non-cases had no appreciable change in trend over time. The propensity matched group demonstrated similar findings with a 10.2% decline in acute care utilization (P&lt0.05) and a 1.1% increase in medication utilization (P&lt0.05). Conclusion: PAP therapy for sleep apnea resulted in a clear reduction in the rate of rise in acute healthcare utilization. A smaller increase in utilization was observed for medications. Given the health and cost implications of acute care hospital stays, these findings suggest that PAP reduces morbidity and that cost-conscious payers have little to fear from wider screening of populations for sleep apnea. Support (If Any): The ResMed Foundation.