Employer-mandated obstructive sleep apnea treatment and healthcare cost savings among truckers

Stephen V Burks; Jon E Anderson; Bibhudutta Panda; Rebecca Haider; Tim Ginader; Nicole Sandback; Darya  Pokutnaya; Derek Toso; Natalie  Hughes; Humza Haider; Resa Brockman; Alice Toll; Nicholas Solberg; Jesse  Eklund; Michael E Cagle; Jeffrey S. Hickman; Erin Mabry; Mark  Berger; Charles A. Czeisler; Stefanos N. Kales

doi:10.1093/sleep/zsz262

Employer-mandated obstructive sleep apnea treatment and healthcare cost savings among truckers

Stephen V Burks, Jon E Anderson, Bibhudutta Panda, Rebecca Haider, Tim Ginader, Nicole Sandback, Darya Pokutnaya, Derek Toso, Natalie Hughes, Humza Haider, Resa Brockman, Alice Toll, Nicholas Solberg, Jesse Eklund, Michael E Cagle, Jeffrey S. Hickman, Erin Mabry, Mark Berger, Charles A. Czeisler, Stefanos N. Kales

Research output: Contribution to journal › Article › peer-review

15 Scopus citations

Abstract

Objective: To evaluate the effect of an employer-mandated obstructive sleep apnea (OSA) diagnosis and treatment program on non-OSA-program trucker medical insurance claim costs. Methods: Retrospective cohort analysis; cohorts constructed by matching (randomly, with replacement) Screen-positive Controls (drivers with insurance screened as likely to have OSA, but not yet diagnosed) with Diagnosed drivers (n = 1,516; cases = 1,224, OSA Negatives = 292), on two factors affecting exposure to medical claims: Experience level at hire and weeks of job tenure at the Diagnosed driver's polysomnogram (PSG) date (the "matching date"). All cases received autoadjusting positive airway pressure (APAP) treatment and were grouped by objective treatment adherence data: Any "Positive Adherence" (n = 932) versus "No Adherence" (n = 292). Bootstrap resampling produced a difference-in-differences estimate of aggregate non-OSA-program medical insurance claim cost savings for 100 Diagnosed drivers as compared to 100 Screen-positive Controls before and after the PSG/matching date, over an 18-month period. A two-part multivariate statistical model was used to set exposures and demographics/anthropometrics equal across sub-groups, and to generate a difference-in-differences comparison across periods that identified the effect of OSA treatment on per-member per-month (PMPM) costs of an individual driver, separately from cost differences associated with adherence choice. Results: Eighteen-month non-OSA-program medical claim costs savings from diagnosing (and treating as required) 100 Screen-positive Controls: $153,042 (95% CI:-$5,352, $330,525). Model-estimated effect of treatment on those adhering to APAP:-$441 PMPM (95% CI:-$861,-$21). Conclusions: Results suggest a carrier-based mandatory OSA program generates substantial savings in non-OSA-program medical insurance claim costs.

Original language	English (US)
Journal	Sleep
Volume	43
Issue number	4
DOIs	https://doi.org/10.1093/sleep/zsz262
State	Published - Apr 15 2020

Bibliographical note

Funding Information:
The research received support from NIH Award #UL1 RR 025758 (Harvard Catalyst, The Harvard Clinical and Translational Science Center, financial contributions from Harvard University and its affiliated academic health care centers) and support from National Surface Transportation Safety Center for Excellence (Project# 12-UI-017). The content is solely the responsibility of the authors and does not necessarily represent the views of the journal or of any of the research sponsors.

Funding Information:
The authors wish to specifically acknowledge the contributions of the journal’s associate editor and anonymous referees, and also the assistance of the executives and staff of the study firm, Schneider Enterprise Resources, LLC (dba Schneider National, Inc.) in acquiring operational and medical data utilized, as well as financial assistance to UMM’s Truckers & Turnover Project from Schneider, the Roadway Safety Institute (the USDOT Region 5 University Transportation Center, which is funded by

Funding Information:
the USDOT Office of the Assistant Secretary for Research and Technology), the MacArthur Foundation’s Research Network on the Origins of Norms and Preferences, the Sloan Foundation, and the University of Minnesota, Morris. Conflict of interest statement. M.B. reports that he is an owner and CEO of Precision Pulmonary Diagnostics, LLC, which has received fees for sleep-apnea-related services from the study firm. In addition, M.B. has been issued US patents 7599892, US 7720696, US 8249896, and US 8200510. C.A.C. reports grants from Cephalon Inc., grants from Mary Ann & Stanley Snider via Combined Jewish Philanthropies, grants from National Football League Charities, grants from Optum, grants from Philips Respironics, Inc., grants from ResMed Foundation, grants from San Francisco Bar Pilots, grants from Schneider Inc., grants from Sysco, grants from Cephalon, Inc, grants from Jazz Pharmaceuticals, grants from Takeda Pharmaceuticals, grants from Teva Pharmaceuticals Industries, Ltd, grants from Sanofi-Aventis, Inc, grants from Sepracor, Inc, grants from Wake Up Narcolepsy, personal fees from Bose Corporation, personal fees from Boston Celtics, personal fees from Boston Red Sox, personal fees from Columbia River Bar Pilots, personal fees from Institute of Digital Media and Child Development, personal fees from Klarman Family Foundation, personal fees from Samsung Electronics, personal fees from Quest Diagnostics, Inc, personal fees from Vanda Pharmaceuticals, personal fees from American Academy of Sleep Medicine (AASM), personal fees from CurtCo Media Labs LLC, personal fees from Global Council on Brain Health/AARP, personal fees from Hawaii Sleep Health and Wellness Foundation, personal fees from Harvard School of Public Health (HSPH), personal fees from Maryland Sleep Society, personal fees from National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), personal fees from National Sleep Foundation (NSF), personal fees from New England College of Optometry, personal fees from University of Michigan, personal fees from University of Washington, personal fees from Zurich Insurance Company, Ltd, personal fees from Purdue Pharma, LP, personal fees from McGraw Hill, personal fees from Houghton Mifflin Harcourt/Penguin, personal fees from Koninklijke Philips Electronics, N.V., personal fees from Cephalon, Inc, personal fees from State of Washington Board of Pilotage Commissioners, personal fees from Ganesco Inc., holds an equity interest in Vanda Pharmaceuticals, outside the submitted work. In addition, C.A.C. holds a number of process patents in the field of sleep/circadian rhythms (e.g. photic resetting of the human circadian pacemaker). Since 1985, C.A.C. has also served as an expert on various legal and technical cases related to sleep and/or circadian rhythms including those involving the following commercial entities: Complete General Construction Company, FedEx, Greyhound, HG Energy LLC, South Carolina Central Railroad Co., Stric-Lan Companies LLC, Texas Premier Resource LLC, and United Parcel Service (UPS). C.A.C.’s interests were reviewed and managed by Brigham and Women’s Hospital and Partners HealthCare in accordance with their conflict of interest policies. S.N.K. has served as a consultant and expert witness on cases involving commercial drivers. J.S.H. has served as an expert witness on cases involving commercial drivers. E.M. reports grants from National Surface Transportation Safety Center for Excellence. The other authors have indicated no financial conflicts of interest. Non-financial disclosure: none.

Publisher Copyright:
© Sleep Research Society 2020. Published by Oxford University Press on behalf of the Sleep Research Society.

Keywords

Commercial motor vehicle operator
Healthy worker selection
Mandatory osa program
Medical insurance costs
Osa
Osa-pap therapy
Treatment adherence
Truckload motor carrier

PubMed: MeSH publication types

Journal Article
Research Support, N.I.H., Extramural

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10.1093/sleep/zsz262

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Employers target workers' sleep to help lower health care costs
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Burks, S. V., Anderson, J. E., Panda, B., Haider, R., Ginader, T., Sandback, N., Pokutnaya, D., Toso, D., Hughes, N., Haider, H., Brockman, R., Toll, A., Solberg, N., Eklund, J., Cagle, M. E., Hickman, J. S., Mabry, E., Berger, M., Czeisler, C. A., & Kales, S. N. (2020). Employer-mandated obstructive sleep apnea treatment and healthcare cost savings among truckers. Sleep, 43(4). https://doi.org/10.1093/sleep/zsz262

Burks, SV, Anderson, JE, Panda, B, Haider, R, Ginader, T, Sandback, N, Pokutnaya, D, Toso, D, Hughes, N, Haider, H, Brockman, R, Toll, A, Solberg, N, Eklund, J, Cagle, ME, Hickman, JS, Mabry, E, Berger, M, Czeisler, CA & Kales, SN 2020, 'Employer-mandated obstructive sleep apnea treatment and healthcare cost savings among truckers', Sleep, vol. 43, no. 4. https://doi.org/10.1093/sleep/zsz262

@article{5b20a248416b4cd9842d686697f344ca,

title = "Employer-mandated obstructive sleep apnea treatment and healthcare cost savings among truckers",

abstract = "Objective: To evaluate the effect of an employer-mandated obstructive sleep apnea (OSA) diagnosis and treatment program on non-OSA-program trucker medical insurance claim costs. Methods: Retrospective cohort analysis; cohorts constructed by matching (randomly, with replacement) Screen-positive Controls (drivers with insurance screened as likely to have OSA, but not yet diagnosed) with Diagnosed drivers (n = 1,516; cases = 1,224, OSA Negatives = 292), on two factors affecting exposure to medical claims: Experience level at hire and weeks of job tenure at the Diagnosed driver's polysomnogram (PSG) date (the {"}matching date{"}). All cases received autoadjusting positive airway pressure (APAP) treatment and were grouped by objective treatment adherence data: Any {"}Positive Adherence{"} (n = 932) versus {"}No Adherence{"} (n = 292). Bootstrap resampling produced a difference-in-differences estimate of aggregate non-OSA-program medical insurance claim cost savings for 100 Diagnosed drivers as compared to 100 Screen-positive Controls before and after the PSG/matching date, over an 18-month period. A two-part multivariate statistical model was used to set exposures and demographics/anthropometrics equal across sub-groups, and to generate a difference-in-differences comparison across periods that identified the effect of OSA treatment on per-member per-month (PMPM) costs of an individual driver, separately from cost differences associated with adherence choice. Results: Eighteen-month non-OSA-program medical claim costs savings from diagnosing (and treating as required) 100 Screen-positive Controls: $153,042 (95% CI:-$5,352, $330,525). Model-estimated effect of treatment on those adhering to APAP:-$441 PMPM (95% CI:-$861,-$21). Conclusions: Results suggest a carrier-based mandatory OSA program generates substantial savings in non-OSA-program medical insurance claim costs.",

keywords = "Commercial motor vehicle operator, Healthy worker selection, Mandatory osa program, Medical insurance costs, Osa, Osa-pap therapy, Treatment adherence, Truckload motor carrier",

author = "Burks, {Stephen V} and Anderson, {Jon E} and Bibhudutta Panda and Rebecca Haider and Tim Ginader and Nicole Sandback and Darya Pokutnaya and Derek Toso and Natalie Hughes and Humza Haider and Resa Brockman and Alice Toll and Nicholas Solberg and Jesse Eklund and Cagle, {Michael E} and Hickman, {Jeffrey S.} and Erin Mabry and Mark Berger and Czeisler, {Charles A.} and Kales, {Stefanos N.}",

note = "Funding Information: The research received support from NIH Award #UL1 RR 025758 (Harvard Catalyst, The Harvard Clinical and Translational Science Center, financial contributions from Harvard University and its affiliated academic health care centers) and support from National Surface Transportation Safety Center for Excellence (Project# 12-UI-017). The content is solely the responsibility of the authors and does not necessarily represent the views of the journal or of any of the research sponsors. Funding Information: The authors wish to specifically acknowledge the contributions of the journal{\textquoteright}s associate editor and anonymous referees, and also the assistance of the executives and staff of the study firm, Schneider Enterprise Resources, LLC (dba Schneider National, Inc.) in acquiring operational and medical data utilized, as well as financial assistance to UMM{\textquoteright}s Truckers & Turnover Project from Schneider, the Roadway Safety Institute (the USDOT Region 5 University Transportation Center, which is funded by Funding Information: the USDOT Office of the Assistant Secretary for Research and Technology), the MacArthur Foundation{\textquoteright}s Research Network on the Origins of Norms and Preferences, the Sloan Foundation, and the University of Minnesota, Morris. Conflict of interest statement. M.B. reports that he is an owner and CEO of Precision Pulmonary Diagnostics, LLC, which has received fees for sleep-apnea-related services from the study firm. In addition, M.B. has been issued US patents 7599892, US 7720696, US 8249896, and US 8200510. C.A.C. reports grants from Cephalon Inc., grants from Mary Ann & Stanley Snider via Combined Jewish Philanthropies, grants from National Football League Charities, grants from Optum, grants from Philips Respironics, Inc., grants from ResMed Foundation, grants from San Francisco Bar Pilots, grants from Schneider Inc., grants from Sysco, grants from Cephalon, Inc, grants from Jazz Pharmaceuticals, grants from Takeda Pharmaceuticals, grants from Teva Pharmaceuticals Industries, Ltd, grants from Sanofi-Aventis, Inc, grants from Sepracor, Inc, grants from Wake Up Narcolepsy, personal fees from Bose Corporation, personal fees from Boston Celtics, personal fees from Boston Red Sox, personal fees from Columbia River Bar Pilots, personal fees from Institute of Digital Media and Child Development, personal fees from Klarman Family Foundation, personal fees from Samsung Electronics, personal fees from Quest Diagnostics, Inc, personal fees from Vanda Pharmaceuticals, personal fees from American Academy of Sleep Medicine (AASM), personal fees from CurtCo Media Labs LLC, personal fees from Global Council on Brain Health/AARP, personal fees from Hawaii Sleep Health and Wellness Foundation, personal fees from Harvard School of Public Health (HSPH), personal fees from Maryland Sleep Society, personal fees from National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), personal fees from National Sleep Foundation (NSF), personal fees from New England College of Optometry, personal fees from University of Michigan, personal fees from University of Washington, personal fees from Zurich Insurance Company, Ltd, personal fees from Purdue Pharma, LP, personal fees from McGraw Hill, personal fees from Houghton Mifflin Harcourt/Penguin, personal fees from Koninklijke Philips Electronics, N.V., personal fees from Cephalon, Inc, personal fees from State of Washington Board of Pilotage Commissioners, personal fees from Ganesco Inc., holds an equity interest in Vanda Pharmaceuticals, outside the submitted work. In addition, C.A.C. holds a number of process patents in the field of sleep/circadian rhythms (e.g. photic resetting of the human circadian pacemaker). Since 1985, C.A.C. has also served as an expert on various legal and technical cases related to sleep and/or circadian rhythms including those involving the following commercial entities: Complete General Construction Company, FedEx, Greyhound, HG Energy LLC, South Carolina Central Railroad Co., Stric-Lan Companies LLC, Texas Premier Resource LLC, and United Parcel Service (UPS). C.A.C.{\textquoteright}s interests were reviewed and managed by Brigham and Women{\textquoteright}s Hospital and Partners HealthCare in accordance with their conflict of interest policies. S.N.K. has served as a consultant and expert witness on cases involving commercial drivers. J.S.H. has served as an expert witness on cases involving commercial drivers. E.M. reports grants from National Surface Transportation Safety Center for Excellence. The other authors have indicated no financial conflicts of interest. Non-financial disclosure: none. Publisher Copyright: {\textcopyright} Sleep Research Society 2020. Published by Oxford University Press on behalf of the Sleep Research Society.",

year = "2020",

month = apr,

day = "15",

doi = "10.1093/sleep/zsz262",

language = "English (US)",

volume = "43",

journal = "Sleep",

issn = "0161-8105",

publisher = "American Academy of Sleep Medicine",

number = "4",

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TY - JOUR

T1 - Employer-mandated obstructive sleep apnea treatment and healthcare cost savings among truckers

AU - Burks, Stephen V

AU - Anderson, Jon E

AU - Panda, Bibhudutta

AU - Haider, Rebecca

AU - Ginader, Tim

AU - Sandback, Nicole

AU - Pokutnaya, Darya

AU - Toso, Derek

AU - Hughes, Natalie

AU - Haider, Humza

AU - Brockman, Resa

AU - Toll, Alice

AU - Solberg, Nicholas

AU - Eklund, Jesse

AU - Cagle, Michael E

AU - Hickman, Jeffrey S.

AU - Mabry, Erin

AU - Berger, Mark

AU - Czeisler, Charles A.

AU - Kales, Stefanos N.

N1 - Funding Information: The research received support from NIH Award #UL1 RR 025758 (Harvard Catalyst, The Harvard Clinical and Translational Science Center, financial contributions from Harvard University and its affiliated academic health care centers) and support from National Surface Transportation Safety Center for Excellence (Project# 12-UI-017). The content is solely the responsibility of the authors and does not necessarily represent the views of the journal or of any of the research sponsors. Funding Information: The authors wish to specifically acknowledge the contributions of the journal’s associate editor and anonymous referees, and also the assistance of the executives and staff of the study firm, Schneider Enterprise Resources, LLC (dba Schneider National, Inc.) in acquiring operational and medical data utilized, as well as financial assistance to UMM’s Truckers & Turnover Project from Schneider, the Roadway Safety Institute (the USDOT Region 5 University Transportation Center, which is funded by Funding Information: the USDOT Office of the Assistant Secretary for Research and Technology), the MacArthur Foundation’s Research Network on the Origins of Norms and Preferences, the Sloan Foundation, and the University of Minnesota, Morris. Conflict of interest statement. M.B. reports that he is an owner and CEO of Precision Pulmonary Diagnostics, LLC, which has received fees for sleep-apnea-related services from the study firm. In addition, M.B. has been issued US patents 7599892, US 7720696, US 8249896, and US 8200510. C.A.C. reports grants from Cephalon Inc., grants from Mary Ann & Stanley Snider via Combined Jewish Philanthropies, grants from National Football League Charities, grants from Optum, grants from Philips Respironics, Inc., grants from ResMed Foundation, grants from San Francisco Bar Pilots, grants from Schneider Inc., grants from Sysco, grants from Cephalon, Inc, grants from Jazz Pharmaceuticals, grants from Takeda Pharmaceuticals, grants from Teva Pharmaceuticals Industries, Ltd, grants from Sanofi-Aventis, Inc, grants from Sepracor, Inc, grants from Wake Up Narcolepsy, personal fees from Bose Corporation, personal fees from Boston Celtics, personal fees from Boston Red Sox, personal fees from Columbia River Bar Pilots, personal fees from Institute of Digital Media and Child Development, personal fees from Klarman Family Foundation, personal fees from Samsung Electronics, personal fees from Quest Diagnostics, Inc, personal fees from Vanda Pharmaceuticals, personal fees from American Academy of Sleep Medicine (AASM), personal fees from CurtCo Media Labs LLC, personal fees from Global Council on Brain Health/AARP, personal fees from Hawaii Sleep Health and Wellness Foundation, personal fees from Harvard School of Public Health (HSPH), personal fees from Maryland Sleep Society, personal fees from National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), personal fees from National Sleep Foundation (NSF), personal fees from New England College of Optometry, personal fees from University of Michigan, personal fees from University of Washington, personal fees from Zurich Insurance Company, Ltd, personal fees from Purdue Pharma, LP, personal fees from McGraw Hill, personal fees from Houghton Mifflin Harcourt/Penguin, personal fees from Koninklijke Philips Electronics, N.V., personal fees from Cephalon, Inc, personal fees from State of Washington Board of Pilotage Commissioners, personal fees from Ganesco Inc., holds an equity interest in Vanda Pharmaceuticals, outside the submitted work. In addition, C.A.C. holds a number of process patents in the field of sleep/circadian rhythms (e.g. photic resetting of the human circadian pacemaker). Since 1985, C.A.C. has also served as an expert on various legal and technical cases related to sleep and/or circadian rhythms including those involving the following commercial entities: Complete General Construction Company, FedEx, Greyhound, HG Energy LLC, South Carolina Central Railroad Co., Stric-Lan Companies LLC, Texas Premier Resource LLC, and United Parcel Service (UPS). C.A.C.’s interests were reviewed and managed by Brigham and Women’s Hospital and Partners HealthCare in accordance with their conflict of interest policies. S.N.K. has served as a consultant and expert witness on cases involving commercial drivers. J.S.H. has served as an expert witness on cases involving commercial drivers. E.M. reports grants from National Surface Transportation Safety Center for Excellence. The other authors have indicated no financial conflicts of interest. Non-financial disclosure: none. Publisher Copyright: © Sleep Research Society 2020. Published by Oxford University Press on behalf of the Sleep Research Society.

PY - 2020/4/15

Y1 - 2020/4/15

N2 - Objective: To evaluate the effect of an employer-mandated obstructive sleep apnea (OSA) diagnosis and treatment program on non-OSA-program trucker medical insurance claim costs. Methods: Retrospective cohort analysis; cohorts constructed by matching (randomly, with replacement) Screen-positive Controls (drivers with insurance screened as likely to have OSA, but not yet diagnosed) with Diagnosed drivers (n = 1,516; cases = 1,224, OSA Negatives = 292), on two factors affecting exposure to medical claims: Experience level at hire and weeks of job tenure at the Diagnosed driver's polysomnogram (PSG) date (the "matching date"). All cases received autoadjusting positive airway pressure (APAP) treatment and were grouped by objective treatment adherence data: Any "Positive Adherence" (n = 932) versus "No Adherence" (n = 292). Bootstrap resampling produced a difference-in-differences estimate of aggregate non-OSA-program medical insurance claim cost savings for 100 Diagnosed drivers as compared to 100 Screen-positive Controls before and after the PSG/matching date, over an 18-month period. A two-part multivariate statistical model was used to set exposures and demographics/anthropometrics equal across sub-groups, and to generate a difference-in-differences comparison across periods that identified the effect of OSA treatment on per-member per-month (PMPM) costs of an individual driver, separately from cost differences associated with adherence choice. Results: Eighteen-month non-OSA-program medical claim costs savings from diagnosing (and treating as required) 100 Screen-positive Controls: $153,042 (95% CI:-$5,352, $330,525). Model-estimated effect of treatment on those adhering to APAP:-$441 PMPM (95% CI:-$861,-$21). Conclusions: Results suggest a carrier-based mandatory OSA program generates substantial savings in non-OSA-program medical insurance claim costs.

AB - Objective: To evaluate the effect of an employer-mandated obstructive sleep apnea (OSA) diagnosis and treatment program on non-OSA-program trucker medical insurance claim costs. Methods: Retrospective cohort analysis; cohorts constructed by matching (randomly, with replacement) Screen-positive Controls (drivers with insurance screened as likely to have OSA, but not yet diagnosed) with Diagnosed drivers (n = 1,516; cases = 1,224, OSA Negatives = 292), on two factors affecting exposure to medical claims: Experience level at hire and weeks of job tenure at the Diagnosed driver's polysomnogram (PSG) date (the "matching date"). All cases received autoadjusting positive airway pressure (APAP) treatment and were grouped by objective treatment adherence data: Any "Positive Adherence" (n = 932) versus "No Adherence" (n = 292). Bootstrap resampling produced a difference-in-differences estimate of aggregate non-OSA-program medical insurance claim cost savings for 100 Diagnosed drivers as compared to 100 Screen-positive Controls before and after the PSG/matching date, over an 18-month period. A two-part multivariate statistical model was used to set exposures and demographics/anthropometrics equal across sub-groups, and to generate a difference-in-differences comparison across periods that identified the effect of OSA treatment on per-member per-month (PMPM) costs of an individual driver, separately from cost differences associated with adherence choice. Results: Eighteen-month non-OSA-program medical claim costs savings from diagnosing (and treating as required) 100 Screen-positive Controls: $153,042 (95% CI:-$5,352, $330,525). Model-estimated effect of treatment on those adhering to APAP:-$441 PMPM (95% CI:-$861,-$21). Conclusions: Results suggest a carrier-based mandatory OSA program generates substantial savings in non-OSA-program medical insurance claim costs.

KW - Commercial motor vehicle operator

KW - Healthy worker selection

KW - Mandatory osa program

KW - Medical insurance costs

KW - Osa

KW - Osa-pap therapy

KW - Treatment adherence

KW - Truckload motor carrier

U2 - 10.1093/sleep/zsz262

DO - 10.1093/sleep/zsz262

M3 - Article

C2 - 31648298

SN - 0161-8105

VL - 43

JO - Sleep

JF - Sleep

IS - 4

ER -

Employer-mandated obstructive sleep apnea treatment and healthcare cost savings among truckers

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

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Employers target workers' sleep to help lower health care costs

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