Refill rates of accessories for positive airway pressure therapy as a surrogate measure of long-term adherence

Nimesh Patel, Afshin Sam, Alexandra Valentin, Stuart F Quan, Sairam Parthasarathy

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Study objectives: To identify and validate a surrogate measure of long-term adherence to positive airway pressure (PAP) therapy in patients with obstructive sleep apnea (OSA). Design: Retrospective cohort study. Setting: Academic center. Participants: 220 consecutive patients with OSA. Interventions: N/A. Measurements: In patients with OSA who were receiving PAP therapy (for > 1 year), PAP adherence measured by device-download and defined by Medicare criteria was compared to refill rates for mask and other PAP therapy accessories. First, receiver operating characteristic (ROC) curves were constructed to identify a threshold value of refills per year that discriminated best between PAP adherent and non-adherent patients (derivation set; n = 100). Then the predictive accuracy of the threshold value of refills per year was tested in an additional 120 consecutive patients (validation set). Results: From the derivation set, ROC curve with good discriminant characteristics (ROC 0.83; 95% confidence intervals [CI], 0.75, 0.91, p < 0.0001) was used to identify a threshold value of refills (0.7 refills/year) for distinguishing PAP adherent and non-adherent patients. Subsequently, when the threshold was applied to the validation set, the likelihood ratio for a positive test (weighted for prevalence) predicting adherence to PAP therapy was 7.3 (95%CI, 3.8, 14), and likelihood ratio for a negative test was 0.6 (95%CI; 0.4, 0.8). Conclusion: Refill rate of PAP accessories exhibited good test characteristics for predicting long-term PAP adherence. Such a surrogate measure based upon insurance claims data can be a powerful epidemiological tool in bioinformatics-aided comparative-effectiveness research and to monitor clinical performance of health systems.

Original languageEnglish (US)
Pages (from-to)169-175
Number of pages7
JournalJournal of Clinical Sleep Medicine
Volume8
Issue number2
DOIs
StatePublished - Apr 15 2012

Fingerprint

Pressure
Obstructive Sleep Apnea
ROC Curve
Therapeutics
Confidence Intervals
Comparative Effectiveness Research
Masks
Medicare
Insurance
Computational Biology
Cohort Studies
Retrospective Studies
Equipment and Supplies
Health

Keywords

  • Adherence
  • Adult
  • Artificial respiration
  • Compliance
  • Continuous positive airway pressure
  • Obstructive sleep apnea
  • Sleep apnea

ASJC Scopus subject areas

  • Clinical Neurology
  • Pulmonary and Respiratory Medicine
  • Neurology

Cite this

Refill rates of accessories for positive airway pressure therapy as a surrogate measure of long-term adherence. / Patel, Nimesh; Sam, Afshin; Valentin, Alexandra; Quan, Stuart F; Parthasarathy, Sairam.

In: Journal of Clinical Sleep Medicine, Vol. 8, No. 2, 15.04.2012, p. 169-175.

Research output: Contribution to journalArticle

@article{714d7ddfc1824006903b2da194212aad,
title = "Refill rates of accessories for positive airway pressure therapy as a surrogate measure of long-term adherence",
abstract = "Study objectives: To identify and validate a surrogate measure of long-term adherence to positive airway pressure (PAP) therapy in patients with obstructive sleep apnea (OSA). Design: Retrospective cohort study. Setting: Academic center. Participants: 220 consecutive patients with OSA. Interventions: N/A. Measurements: In patients with OSA who were receiving PAP therapy (for > 1 year), PAP adherence measured by device-download and defined by Medicare criteria was compared to refill rates for mask and other PAP therapy accessories. First, receiver operating characteristic (ROC) curves were constructed to identify a threshold value of refills per year that discriminated best between PAP adherent and non-adherent patients (derivation set; n = 100). Then the predictive accuracy of the threshold value of refills per year was tested in an additional 120 consecutive patients (validation set). Results: From the derivation set, ROC curve with good discriminant characteristics (ROC 0.83; 95{\%} confidence intervals [CI], 0.75, 0.91, p < 0.0001) was used to identify a threshold value of refills (0.7 refills/year) for distinguishing PAP adherent and non-adherent patients. Subsequently, when the threshold was applied to the validation set, the likelihood ratio for a positive test (weighted for prevalence) predicting adherence to PAP therapy was 7.3 (95{\%}CI, 3.8, 14), and likelihood ratio for a negative test was 0.6 (95{\%}CI; 0.4, 0.8). Conclusion: Refill rate of PAP accessories exhibited good test characteristics for predicting long-term PAP adherence. Such a surrogate measure based upon insurance claims data can be a powerful epidemiological tool in bioinformatics-aided comparative-effectiveness research and to monitor clinical performance of health systems.",
keywords = "Adherence, Adult, Artificial respiration, Compliance, Continuous positive airway pressure, Obstructive sleep apnea, Sleep apnea",
author = "Nimesh Patel and Afshin Sam and Alexandra Valentin and Quan, {Stuart F} and Sairam Parthasarathy",
year = "2012",
month = "4",
day = "15",
doi = "10.5664/jcsm.1772",
language = "English (US)",
volume = "8",
pages = "169--175",
journal = "Journal of Clinical Sleep Medicine",
issn = "1550-9389",
publisher = "American Academy of Sleep Medicine",
number = "2",

}

TY - JOUR

T1 - Refill rates of accessories for positive airway pressure therapy as a surrogate measure of long-term adherence

AU - Patel, Nimesh

AU - Sam, Afshin

AU - Valentin, Alexandra

AU - Quan, Stuart F

AU - Parthasarathy, Sairam

PY - 2012/4/15

Y1 - 2012/4/15

N2 - Study objectives: To identify and validate a surrogate measure of long-term adherence to positive airway pressure (PAP) therapy in patients with obstructive sleep apnea (OSA). Design: Retrospective cohort study. Setting: Academic center. Participants: 220 consecutive patients with OSA. Interventions: N/A. Measurements: In patients with OSA who were receiving PAP therapy (for > 1 year), PAP adherence measured by device-download and defined by Medicare criteria was compared to refill rates for mask and other PAP therapy accessories. First, receiver operating characteristic (ROC) curves were constructed to identify a threshold value of refills per year that discriminated best between PAP adherent and non-adherent patients (derivation set; n = 100). Then the predictive accuracy of the threshold value of refills per year was tested in an additional 120 consecutive patients (validation set). Results: From the derivation set, ROC curve with good discriminant characteristics (ROC 0.83; 95% confidence intervals [CI], 0.75, 0.91, p < 0.0001) was used to identify a threshold value of refills (0.7 refills/year) for distinguishing PAP adherent and non-adherent patients. Subsequently, when the threshold was applied to the validation set, the likelihood ratio for a positive test (weighted for prevalence) predicting adherence to PAP therapy was 7.3 (95%CI, 3.8, 14), and likelihood ratio for a negative test was 0.6 (95%CI; 0.4, 0.8). Conclusion: Refill rate of PAP accessories exhibited good test characteristics for predicting long-term PAP adherence. Such a surrogate measure based upon insurance claims data can be a powerful epidemiological tool in bioinformatics-aided comparative-effectiveness research and to monitor clinical performance of health systems.

AB - Study objectives: To identify and validate a surrogate measure of long-term adherence to positive airway pressure (PAP) therapy in patients with obstructive sleep apnea (OSA). Design: Retrospective cohort study. Setting: Academic center. Participants: 220 consecutive patients with OSA. Interventions: N/A. Measurements: In patients with OSA who were receiving PAP therapy (for > 1 year), PAP adherence measured by device-download and defined by Medicare criteria was compared to refill rates for mask and other PAP therapy accessories. First, receiver operating characteristic (ROC) curves were constructed to identify a threshold value of refills per year that discriminated best between PAP adherent and non-adherent patients (derivation set; n = 100). Then the predictive accuracy of the threshold value of refills per year was tested in an additional 120 consecutive patients (validation set). Results: From the derivation set, ROC curve with good discriminant characteristics (ROC 0.83; 95% confidence intervals [CI], 0.75, 0.91, p < 0.0001) was used to identify a threshold value of refills (0.7 refills/year) for distinguishing PAP adherent and non-adherent patients. Subsequently, when the threshold was applied to the validation set, the likelihood ratio for a positive test (weighted for prevalence) predicting adherence to PAP therapy was 7.3 (95%CI, 3.8, 14), and likelihood ratio for a negative test was 0.6 (95%CI; 0.4, 0.8). Conclusion: Refill rate of PAP accessories exhibited good test characteristics for predicting long-term PAP adherence. Such a surrogate measure based upon insurance claims data can be a powerful epidemiological tool in bioinformatics-aided comparative-effectiveness research and to monitor clinical performance of health systems.

KW - Adherence

KW - Adult

KW - Artificial respiration

KW - Compliance

KW - Continuous positive airway pressure

KW - Obstructive sleep apnea

KW - Sleep apnea

UR - http://www.scopus.com/inward/record.url?scp=84861169498&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84861169498&partnerID=8YFLogxK

U2 - 10.5664/jcsm.1772

DO - 10.5664/jcsm.1772

M3 - Article

C2 - 22505862

AN - SCOPUS:84861169498

VL - 8

SP - 169

EP - 175

JO - Journal of Clinical Sleep Medicine

JF - Journal of Clinical Sleep Medicine

SN - 1550-9389

IS - 2

ER -