OSA is a condition in which a person’s airway closes repeatedly while sleeping, causing the individual to partially wake up each time, though not enough to be aware of what is happening. Sufferers do not get fully restful sleep, which negatively affects many other medical conditions.
Despite evidence that untreated OSA is associated with significantly higher rates of serious preventable truck crashes, the U.S. Department of Transportation (USDOT) dropped an inquiry about requiring screening commercial vehicle operators for this disease in 2017. Part of the reason was motor carrier concern about cost. In new research published in the medical journal Sleep, the U of M Morris-led research team addressed this concern by identifying the savings on the costs of other medical conditions that result from treating OSA.
Researchers analyzed the medical insurance claims of drivers enrolled in the study firm’s sleep apnea screening, diagnosis and treatment program. To estimate the savings in claims for an individual driver receiving treatment, the research team used a multivariate model to compare the costs of drivers accepting treatment and those refusing it. After excluding claims related to the program itself, they found a savings of $441 per driver per month for the typical driver who accepted treatment.
To estimate the aggregate savings for 100 drivers who were diagnosed and treated, the researchers compared them to 100 “screen-positive” controls (drivers screened as likely to have OSA who had not yet been diagnosed). The cases and screen-positive controls were matched on characteristics (e.g. job tenure) that affected their likelihood of entering the study. The researchers found a savings of $153,000 for 100 drivers over 18 months. Additional savings came from increased employee retention among treated drivers.
This study found that:
- an employer-mandated program to screen, diagnose and treat truck drivers for OSA saved the study firm $441 per driver per month in non-OSA-program medical insurance costs;
- the aggregate medical cost savings ($153,000 for 100 drivers over 18 months) were reduced somewhat by driver turnover, but treated drivers were also retained longer. The total savings were sufficient to substantially offset the cost of operating a mandatory OSA program.
"The individual saving of $441 per-driver per-month due to the effective treatment of this disease is very substantial, and deserves attention from everyone who is concerned about high medical insurance costs," said Steve Burks, a professor at U of M Morris. "The aggregate savings for 100 drivers, along with higher retention of treated drivers, were sufficient to offset much of the cost to the study firm of operating an OSA program."
These results provide a clear example in which effectively treating a significant disease lowers the costs for treating associated conditions, of interest to many in an era of rising medical costs. In addition to the safety benefits shown earlier, the substantial savings from treating OSA should help mitigate trucking industry cost concerns when the USDOT takes up the issue of mandatory screening for OSA among truck drivers again in the future.
The statistical analysis was performed at the U of M Morris, where eleven U of M Morris students and three faculty members were co-authors. Co-authors at Harvard Medical School and Virginia Tech Transportation Institute also contributed to the work. Both analyses compared costs before and after the OSA diagnosis to control for unmeasured initial differences between groups being analyzed. The full costs of the OSA program itself were not available for the study.
This research was funded by the Region 5 Roadway Safety Institute, the U of M Morris, the study firm, Harvard University, and Virginia Tech Transportation Institute.
Stephen Burks is an expert in experimental and behavioral personnel economics and the economics of the U.S. trucking industry. He is a professor of economics and management and principal investigator of the Truckers & Turnover Project at U of M Morris, and research scholar at the Center for Transportation Studies. Co-investigators of the Truckers & Turnover Project are Jon Anderson, a biostatistics expert and professor of statistics, and Bibhudutta Panda, an applied econometrics expert and associate professor of economics and management, at U of M Morris.
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