OBJECTIVES: Individuals diagnosed with obstructive sleep apnea (OSA) having comorbid chronic non-cancer pain (CNCP) represent a clinically important sub-group that may have high healthcare resource utilization (HcRU) and costs. Our objective was to compare HcRU and direct medical costs among those with OSA+CNCP versus OSA alone.

METHODS: This retrospective cohort study used a 10% random sample of enrollees within the IQVIA^TM PharMetrics Plus adjudicated claims database. We identified individuals aged 18-64 diagnosed with OSA between 2006 - 2015. Among these, the presence of CNCP was examined at baseline (12-months prior OSA diagnosis) and both groups were matched on baseline covariates. Logistic regression models were used to identify the association between OSA + CNCP and binary outcomes (i.e., inpatient hospitalization and emergency department (ED) visits) during the first year of follow-up. Generalized linear models were used to assess similar associations with HcRU (office visits, outpatient visits, number of unique drug classes used) and costs during the same period.

RESULTS: Of the 69,921 individuals with OSA (unmatched sample), 60% had at least one CNCP condition at baseline. In the matched sample, individuals with OSA+CNCP displayed higher adjusted odds ratios (AOR’s) for experiencing an inpatient hospitalization; AOR (95% CI): 1.34 (1.25, 1.43) and an ED visit; AOR: 1.30 (1.24, 1.36) compared to individuals with OSA only. They also had higher rates of outpatient visits based on incident rate ratios (IRRs); IRR (95% CI): 1.15 (1.14, 1.17), office visits; IRR: 1.46 (1.44, 1.48) and drug class use; IRR: 1.09 (1.08, 1.11) as compared to OSA-only controls. Individuals with OSA+ CNCP incurred 1.16 times (95% CI: 1.14, 1.18) higher costs compared to their OSA-only counterparts.

CONCLUSIONS: Individuals with OSA+CNCP have higher HcRU and costs as compared to individuals with OSA only. These findings can guide healthcare planners to target allocation of resources effectively toward this at-risk subgroup within OSA patients.