Use of Telemonitoring for CPAP Therapy Control in OSA Patients: Impact on Cost and Process Improvements

Home Respiratory Therapies in Patients With Obstructive Sleep Apnea: A Value-based Care Model in Spain

This document proposes a value-based care model to improve adherence and health outcomes in patients with obstructive sleep apnea (OSA) treated with CPAP. The current care model for OSA management adopts a uniform, volume-based approach for all patients, limiting personalized care and reducing service quality without providing objective outcome data. The value-based care model proposed here focuses on guiding all interventions towards improving treatment adherence, aiming to enhance health outcomes by increasing patients' quality of life and comfort with treatment. Key strategies to be implemented include education and support programs at the beginning of treatment, enhancing comfort in mask use, telemonitoring of adherence, patient involvement in the treatment progress, patient stratification based on adherence, and identifying individuals who may benefit from alternative treatments. A results-based funding model is also recommended to optimize resource allocation. Expected outcomes from these measures include a reduction in home visits and in-person consultations for stable patients, fewer non-adherent patients, more optimally treated patients, and overall improvements in treatment quality and effectiveness. Key indicators to evaluate the success of this approach include quality of life (measured through quality-of-life questionnaires), adherence levels (via telemonitoring), and CPAP comfort. Collectively, these strategies allow for a comprehensive approach, optimizing resources and ensuring personalized care that improves the experience and outcomes of OSA patients.

[Home CPAP Remote Monitoring as a System to Control Adaptation and Titration in Obstructive Sleep Apnoea and its Impact on the Management of this Pathology (T-CPAP Project)]

Introduction

Continuous Positive Airway Pressure (CPAP) constitutes the most effective treatment for Obstructive Sleep Apnea (OSA). Automatic titration systems (ATS) are predominantly used to achieve adaptation to the equipment. Home CPAP devices allow telemonitoring (TM) of the same parameters as those provided by ATS but with access to continuous usage data. Under this premise, we conducted a study on the potential validity of TM for home CPAP devices as a titration system, its direct impact on proper adaptation (AD) to the equipment, and secondarily on the healthcare resources employed to achieve it.

Material and methods

An observational study involving 318 patients with OSA who were titrated using TM to achieve AD to CPAP. Patients with OSA were consecutively recruited and evaluated at 1, 3, and 6 months after initiating treatment. Results were compared with a historical group of 307 patients with OSA who achieved AD to CPAP using ATS. Additionally, we assessed the impact on required healthcare resources.

Results

Patients with OSA who initiated CPAP treatment with TM over the first six months showed a similar AD rate compared to the historical group titrated using ATS, with lower resource usage in the TM group.

Conclusion

Data provided by TM of home CPAP devices allow for titration and achieving similar AD as with ATS in non-complex patients.

The Value of Implementing a Digital Approach in the Obstructive Sleep Apnoea Patient Pathway: A Spanish Example

Introduction

Continuous positive airway pressure (CPAP) is the gold standard therapy for obstructive sleep apnoea (OSA). However, non-adherence is common and costly. The COVID-19 pandemic required the use of novel solutions to ensure service provision and quality of care. This retrospective analysis determined the impact and value of a digital versus standard pathway for the management of OSA in Spain.

Methods

A time-driven activity-based costing approach was applied to OSA management over 1 year using a standard or digital pathway. The standard pathway included face-to-face appointments at the time of diagnosis, then after 1-3 months and every 6 months thereafter. The digital pathway had fewer face-to-face appointments and utilised telemonitoring. A cost analysis was performed to determine the per-patient cost per healthcare professional (HCP) for a digital pathway for therapy implementation and follow-up compared with the standard pathway.

Results

Compared with the standard pathway, the digital pathway decreased the waiting list time from 18 to 2 months, the overall pathway time from 12 to 6 months, HCP cost per patient from €95 to €85, and number of hospital appointments per patient from 6 to 3.1. Furthermore, CPAP device usage improved from 5.7 to 6.3 h/night and the proportion of individuals defined as adherent increased from 79% to 91%.

Conclusions

Implementation of digital processes using available technology reduced HCP time and costs, and improved adherence to CPAP in people with OSA. Greater utilisation of a digital pathway could improve access to therapy, allow personalised patient management, and facilitate better clinical outcomes.