March 30, 2012Open Access

Financial Incentive Increases CPAP Acceptance in Patients from Low Socioeconomic Background

ATAriel TarasiukBen-Gurion University of the Negev GRGally ReznorWilmington University SGSari Greenberg‐DotanSoroka Medical Center

Structured PICO

Does a financial incentive reduce the cost barrier and improve CPAP acceptance in adult patients with obstructive sleep apnea?

Population

258 symptomatic adult obstructive sleep apnea (OSA) patients (ages 25-68 years, naive to CPAP) requiring CPAP treatment (AHI ≥30 events/hour or AHI ≥15 events/hour accompanied by excessive daytime sleepiness with ESS score ≥10 and/or documented cardiovascular disease/hypertension). Excluded patients with mild OSA, requiring bi-level pressure, or language comprehension difficulties.

Intervention

Financial incentive for CPAP device purchase (subsidized price of $55 out-of-pocket co-payment).

Comparator

Standard mandatory out-of-pocket co-payment for CPAP device ($330 to $660 depending on supplementary health insurance coverage).

Outcome

CPAP acceptance (purchasing the device and commencing treatment at the conclusion of the adaptation period, confirmed by downloaded device data).

Minimizing out-of-pocket costs through financial incentives significantly increases CPAP acceptance among low socioeconomic status patients with obstructive sleep apnea.

Abstract

OBJECTIVE: We explored whether financial incentives have a role in patients' decisions to accept (purchase) a continuous positive airway pressure (CPAP) device in a healthcare system that requires cost sharing. DESIGN: Longitudinal interventional study. PATIENTS: The group receiving financial incentive (n = 137, 50. 8±10. 6 years, apnea/hypopnea index (AHI) 38. 7±19. 9 events/hr) and the control group (n = 121, 50. 9±10. 3 years, AHI 39. 9±22) underwent attendant titration and a two-week adaptation to CPAP. Patients in the control group had a co-payment of 330-660; the financial incentive group paid a subsidized price of 55. RESULTS: CPAP acceptance was 43% greater (p = 0. 02) in the financial incentive group. CPAP acceptance among the low socioeconomic strata (n = 113) (adjusting for age, gender, BMI, tobacco smoking) was enhanced by financial incentive (OR, 95% CI) (3. 43, 1. 09-10. 85), age (1. 1, 1. 03-1. 17), AHI (>30 vs. 30 vs. 30 vs. <30) (5. 25, 1. 34-18. 5). CONCLUSIONS: Minimizing cost sharing reduces a barrier for CPAP acceptance among low socioeconomic status patients. Thus, financial incentive should be applied as a policy to encourage CPAP treatment, especially among low socioeconomic strata patients.

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