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Mandatory OSA treatment for truckers lowers insurance costs



Diagnosis and treatment for obstructive sleep apnea resulted in medical cost savings in a group of U.S. truck drivers.

A trucker behind the wheel. welcomia/Getty Images

“Among the 1.87 million U.S. commercial drivers estimated by the Bureau of Labor Statistics to be operating non–farm-based heavy trucks (gross weight at least 26,000 pounds), 17%-28%, or 318,00 to 524,000, are expected to have at least mild [obstructive sleep apnea] based on prevalence studies on commercial drivers,” wrote Stephen V. Burks, PhD, of the University of Minnesota, Morris, and colleagues.

“If the larger population of the 4.0 million drivers estimated by the Federal Motor Carrier Safety Administration to be using commercial driver’s licenses in interstate and intrastate transportation is considered, 0.68 to 1.1 million drivers may have OSA. The majority of these drivers are thought to be undiagnosed and untreated. There is thus considerable scope for healthcare cost savings through treatment of OSA among commercial drivers,” they noted.

The study was published in Sleep.

In 2017, after industry complaints about costs, the federal government withdrew its proposal to mandate testing truckers for OSA. Yet some commercial fleets do require testing, and a new study looking at retrospective data from a large fleet’s health insurance program shows that drivers diagnosed and treated for OSA saw medical cost savings, compared with those considered likely to have OSA who had neither diagnosis nor treatment.

Dr. Burks and his colleagues looked at records for 1,516 drivers tested for OSA, of whom 1,224 were positive, and compared these with an equal number of controls flagged through the same screening program as likely to have OSA, but who had never received a diagnosis in a sleep clinic or treatment with auto-adjusting positive airway pressure (APAP). All cases received auto-adjusting positive airway pressure (APAP) treatment. The investigators then looked at insurance costs for diagnosed drivers, compared with screen-positive controls before and after the polysomnogram date, over an 18-month period.

Most of the diagnosed cases in the cohort (n = 932) were deemed compliant with treatment. For every pair of subjects and controls, the researchers looked at per-member insurance costs over 18 months, though not all drivers were observed for a full period of 18 months, mostly because of turnover. Dr. Burks and colleagues found that non-OSA related medical claim costs savings after diagnosis and treatment of every 100 screen-positive controls was $153,042 (95% confidence interval, –$5,352, $330,525, P = .06.) Subjects adhering to treatment with APAP saw mean non-OSA related savings of $441 per member per month (95% CI, –$861, –$21, P = .035).

“Taken together, this is substantial evidence that OSA treatment is associated with savings in non-OSA–program medical insurance claim costs,” the authors wrote, adding that such savings could be expected to help offset expenses related to mandatory OSA programs. The authors acknowledged as a limitation of their study that it did not capture costs of pharmaceutical treatment or those of the OSA program itself. Nor did the findings capture “the value of injuries, lost work time, or disability days associated with untreated OSA, nor the savings from avoided preventable crashes.”

The study received funding from Harvard University and the National Surface Transportation Safety Center for Excellence. Two coauthors disclosed funding from pharmaceutical and device manufacturers and hold patents on sleep therapies. Another coauthor disclosed being an expert witness in trucking-related cases and one received funds from the study’s sponsor, a trucking safety research group.

SOURCE: Burks SV et al. Sleep 2019 Oct 24. doi: 10.1093/sleep/zsz262.

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