Obstructive Sleep Apnea (OSA) Phenotypes and the Personalized Impact of Positive Airway Pressure (PAP) Therapy on Healthcare Resource Use
Author(s)
Melike Deger Wehr, BSc, MSc1, R Benjamin Dexter, MS2, Caleb Woodford, BMath2, Naomi Alpert, MS3, Will McConnell, MPH, JD, PhD3, Kate V. Cole, MS3.
1Resmed Science Centre, Münich, Germany, 2Resmed Science Centre, Halifax, NS, Canada, 3Resmed Science Center, San Diego, CA, USA.
1Resmed Science Centre, Münich, Germany, 2Resmed Science Centre, Halifax, NS, Canada, 3Resmed Science Center, San Diego, CA, USA.
OBJECTIVES: Phenotyping enhances our understanding of disease heterogeneity and helps predict differential responses to therapies. OSA, affecting nearly 1 billion people worldwide, is well suited for such stratified analysis. We identified phenotypes among newly diagnosed OSA patients based on comorbidities and examined their healthcare resource utilization (HCRU) outcomes following PAP therapy.
METHODS: K-modes cluster analysis was conducted using US administrative claims data from patients newly diagnosed with OSA (January 2015-May 2022). Groups of ICD-9/10 codes (Phecodes) with ≥10% prevalence in the OSA cohort were used to derive patient phenotypes. The cohort was then reduced to those that had objective PAP therapy usage data availability for at least 2 years. HCRU, including emergency room (ER) visits and hospitalizations, was compared for those with an average of ≥4 hours/night to <4 hours/night. Inverse probability of treatment weighting balanced adherence groups on baseline covariates.
RESULTS: Seven OSA phenotypes were identified from nearly 1.8 million patients: 1) low comorbidity burden with obesity, 2) moderate comorbidity burden with obesity, 3) moderate comorbidity burden with less obesity, 4) moderate comorbidity burden with nose and sinus conditions and less obesity, 5) high comorbidity burden with affective and inflammatory conditions, 6) high comorbidity burden with affective conditions, 7) very high comorbidity burden with cardiovascular and metabolic conditions. PAP use was consistently associated with reductions in ER visits and hospitalizations, particularly in higher comorbidity burden phenotypes (5, 6, & 7). In lower comorbidity burden phenotypes (1, 2, 3, & 4), adherent patients experienced modest reductions in ER visits; hospitalization changes were minimal. Lower use in phenotypes 1 & 2 was associated with increased ER visits.
CONCLUSIONS: OSA phenotypes differ in their response to PAP therapy. These findings can guide clinical decision-making by highlighting phenotype-specific HCRU benefits.
METHODS: K-modes cluster analysis was conducted using US administrative claims data from patients newly diagnosed with OSA (January 2015-May 2022). Groups of ICD-9/10 codes (Phecodes) with ≥10% prevalence in the OSA cohort were used to derive patient phenotypes. The cohort was then reduced to those that had objective PAP therapy usage data availability for at least 2 years. HCRU, including emergency room (ER) visits and hospitalizations, was compared for those with an average of ≥4 hours/night to <4 hours/night. Inverse probability of treatment weighting balanced adherence groups on baseline covariates.
RESULTS: Seven OSA phenotypes were identified from nearly 1.8 million patients: 1) low comorbidity burden with obesity, 2) moderate comorbidity burden with obesity, 3) moderate comorbidity burden with less obesity, 4) moderate comorbidity burden with nose and sinus conditions and less obesity, 5) high comorbidity burden with affective and inflammatory conditions, 6) high comorbidity burden with affective conditions, 7) very high comorbidity burden with cardiovascular and metabolic conditions. PAP use was consistently associated with reductions in ER visits and hospitalizations, particularly in higher comorbidity burden phenotypes (5, 6, & 7). In lower comorbidity burden phenotypes (1, 2, 3, & 4), adherent patients experienced modest reductions in ER visits; hospitalization changes were minimal. Lower use in phenotypes 1 & 2 was associated with increased ER visits.
CONCLUSIONS: OSA phenotypes differ in their response to PAP therapy. These findings can guide clinical decision-making by highlighting phenotype-specific HCRU benefits.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE595
Topic
Clinical Outcomes, Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Personalized & Precision Medicine, Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)