(350) Real-world Incremental Economic Burden of Fatigue among Patients with Obstructive Sleep Apnea in the Medicare Fee-for-Service Population

Background: : Fatigue, distinct from sleepiness, is one of the most common obstructive sleep apnea (OSA) symptoms, and is associated with diminished quality of life, poor psychological and physical functioning and increased risk of occupational and motor vehicle accidents.

Objective: : The aim of this study was to estimate the incremental healthcare cost burden of fatigue among patients with OSA in the Medicare fee-for-service (FFS) population.

Methods: : Retrospective observational claims analysis was conducted comparing newly diagnosed OSA patients with fatigue to matched OSA patients without fatigue. Medical and pharmacy claims from the 2017-2022 Medicare FFS database were used to identify incident cases of fatigue among newly diagnosed OSA patients who met the following criteria: ≥1 inpatient or ≥2 outpatient claims (with ≥7 days apart) with an ICD-10-CM diagnosis code of OSA (G47.33, G47.30, G47.39); ≥1 procedure code for polysomnography or home sleep apnea test in 12 months prior to OSA diagnosis index date; continuous insurance coverage ≥12 months before OSA diagnosis index (baseline period) and ≥12 months after fatigue index date (follow-up period). Fatigue cases had ≥1 claim for fatigue (R53.1, R53.81, R53.82, R53.83) after the OSA diagnosis index date. Controls had no diagnosis of fatigue and were propensity score matched to fatigue cases.

Results: : Total of 71,710 newly diagnosed OSA patients met eligibility criteria, of whom ~36% had ≥1 diagnosis claim for fatigue. Mean (SD) age was 72.8 years (5.3), 51% male, and 88% White. After OSA diagnosis, mean all-cause healthcare costs were significantly higher (all p< 0.001) for patients with fatigue vs. matched controls: Per-patient-per-year (PPPY) all-cause hospitalization ($7,642 vs $2,059); outpatient visits ($5,247 vs $2,983); emergency department visits ($870 vs $318); other medical visits ($10,901 vs $5,570); and pharmacy costs ($5,199 vs $3,773). Overall, the mean PPPY all-cause total costs ($29,860 vs $14,702, p< 0.001) in OSA patients with fatigue were significantly higher than those without fatigue, indicating over a two-fold increase.

Conclusions: : Fatigue is significantly associated with an increase in all-cause total healthcare costs in newly diagnosed OSA patients as compared with matched patients without fatigue. Addressing fatigue may be useful as part of OSA screening, diagnosis and treatment due to the incremental humanistic and economic burden.

Sponsorship:: This study was funded by Apnimed, Inc.