The use of health-care resources in obesity-hypoventilation syndrome

Objective: To document health-care utilization (ie, physician claims and ho spitalizations) in patients with obesity-hypoventilation syndrome (OHS), fo r 5 years prior to the diagnosis and for 2 years after the diagnosis and in itiation of treatment. Design: Retrospective observational cohort study. Setting: University-based sleep disorders center in Manitoba, Canada. Patients and control subjects: Twenty OHS patients (mean [+/- SD] age, 52.7 +/- 9.5 years; body mass index [BMI], 47.3 +/- 11.0 kg/m(2); PacO(2), 59.7 +/- 13.8 mm Hg; Pao(2), 51.6 +/- 12.4 min Hg) were matched to two sets of control subjects. First, each case was matched to 15 general population con trol subjects (GPCs) by age, gender, and geographic location, and, second, each case was matched to a single obese control subject (OBC) who was match ed using the same criteria as for the GPCs, plus the measurement of BMI. Measurements and results: In the 5 years before diagnosis, the 20 OHS patie nts had (mean +/- SE) 11.2 +/- 1.8 physician visits per patient per year vs 5.7 +/- 0.8 (p < 0.01) visits for OBCs and 4.5 +/- 0.4 (p < 0.001) visits for GPCs. OHS patients generated higher fees, $623 +/- 96 per patient per y ear for the 5 years prior to diagnosis compared to $252 +/- 34 (p < 0.001) for OBCs and $236 +/- 25 (p < 0.001) for GPCs. OHS patients were much more likely to be hospitalized than were subjects in either control group in the 5 years prior to diagnosis (odds ratio [OR] vs GPCs, 8.6) (95% confidence interval [CI], 5.9 to 12.7); OR vs OBCs, 4.9 (95% CI, 2.3 to 10.1). In the 2 years after diagnosis and the initiation of treatment (usually continuous positive airway pressure or bilevel positive airway pressure), there was a significant linear reduction in physician fees. In the 2 years after the i nitiation of treatment, there was a 68.4% decrease in days hospitalized per year (5 years before treatment, 7.9 days per patient per year; after 2 yea rs of treatment, 2.5 days per patient per year [p = 0.01]). Conclusions: OHS patients are heavy users of health care for several years prior to evaluation and treatment of their sleep breathing disorder; there is a substantial reduction in days hospitalized once the diagnosis is made and treatment is instituted.