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Use of Stimulants and Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnea from a Large Claims Dataset
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A1494 - Use of Stimulants and Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnea from a Large Claims Dataset
Author Block: M. Ohayon1, J. Profant2, S. Gibson2, C. Milesi3; 1Stanford University, Palo Alto, CA, United States, 2Jazz Pharmaceuticals, Palo Alto, CA, United States, 3EvalStat Research Institute, Palo Alto, CA, United States.
RATIONALE: To assess the use of continuous positive airway pressure (CPAP), and stimulants (traditional stimulants and wake-promoting agents [WPAs]) in patients with obstructive sleep apnea (OSA) in United States (US) healthcare claims.
METHODS: A retrospective analysis of US healthcare claims from the Symphony Health Solutions Integrated Dataverse database was conducted. These claims contain patient-level data from physician practices, pharmacies, and hospitals that have been linked by unique patient identifiers (Health Insurance Portability and Accountability Act compliant) for a broad longitudinal view of healthcare delivery and patient usage patterns. Claims from July 2010 through March 2015 were analyzed and patients with ≥1 diagnostic code for OSA were identified. OSA patient claims were further analyzed to assess demographics, CPAP claims, and stimulant claims. In this analysis, traditional stimulants were amphetamines and methylphenidate, and WPAs were modafinil and armodafinil. This large data set is estimated to capture 73% of prescription activity, 55% of medical (physician offices, clinics) claims, and 25% of hospital activity in the US.
RESULTS: A total of 12.4 million OSA patients were identified in the 4.75-year period. Within this time period, 56% of OSA patients had some CPAP use (unknown adherence) and 44% had no CPAP use. Five percent of OSA patients had ≥1 prescription for a stimulant. Of all stimulant use, 55% of OSA patients on stimulants were on CPAP and 45% of OSA patients on stimulants had no CPAP use in the 4.75-year period. Amphetamines/methylphenidate accounted for 70% of stimulant use and modafinil/armodafinil 39% (9% combination use) in OSA patients. Longitudinally, amphetamines/methylphenidate accounted for 51% of first-line therapy and modafinil/armodafinil 49%. Use of amphetamines/methylphenidate increased in later lines of therapy, and use of modafinil/armodafinil decreased.
CONCLUSIONS: In this retrospective claims analysis from July 2010 through March 2015, stimulants were rarely used to treat excessive sleepiness in OSA. Only 5% of OSA patients received a stimulant despite a reported prevalence of persistent excessive sleepiness in 13–65% of patients utilizing CPAP for OSA. Stimulants were used in OSA independently of CPAP use, with almost half of patients with OSA not receiving CPAP. Amphetamines/methylphenidate were used almost twice as often as modafinil/armodafinil in OSA. Limitations of this research include the retrospective study design, lack of confirmed prescribing indications for medication claims, and potential bias related to sampling error.
Author Block: M. Ohayon1, J. Profant2, S. Gibson2, C. Milesi3; 1Stanford University, Palo Alto, CA, United States, 2Jazz Pharmaceuticals, Palo Alto, CA, United States, 3EvalStat Research Institute, Palo Alto, CA, United States.
RATIONALE: To assess the use of continuous positive airway pressure (CPAP), and stimulants (traditional stimulants and wake-promoting agents [WPAs]) in patients with obstructive sleep apnea (OSA) in United States (US) healthcare claims.
METHODS: A retrospective analysis of US healthcare claims from the Symphony Health Solutions Integrated Dataverse database was conducted. These claims contain patient-level data from physician practices, pharmacies, and hospitals that have been linked by unique patient identifiers (Health Insurance Portability and Accountability Act compliant) for a broad longitudinal view of healthcare delivery and patient usage patterns. Claims from July 2010 through March 2015 were analyzed and patients with ≥1 diagnostic code for OSA were identified. OSA patient claims were further analyzed to assess demographics, CPAP claims, and stimulant claims. In this analysis, traditional stimulants were amphetamines and methylphenidate, and WPAs were modafinil and armodafinil. This large data set is estimated to capture 73% of prescription activity, 55% of medical (physician offices, clinics) claims, and 25% of hospital activity in the US.
RESULTS: A total of 12.4 million OSA patients were identified in the 4.75-year period. Within this time period, 56% of OSA patients had some CPAP use (unknown adherence) and 44% had no CPAP use. Five percent of OSA patients had ≥1 prescription for a stimulant. Of all stimulant use, 55% of OSA patients on stimulants were on CPAP and 45% of OSA patients on stimulants had no CPAP use in the 4.75-year period. Amphetamines/methylphenidate accounted for 70% of stimulant use and modafinil/armodafinil 39% (9% combination use) in OSA patients. Longitudinally, amphetamines/methylphenidate accounted for 51% of first-line therapy and modafinil/armodafinil 49%. Use of amphetamines/methylphenidate increased in later lines of therapy, and use of modafinil/armodafinil decreased.
CONCLUSIONS: In this retrospective claims analysis from July 2010 through March 2015, stimulants were rarely used to treat excessive sleepiness in OSA. Only 5% of OSA patients received a stimulant despite a reported prevalence of persistent excessive sleepiness in 13–65% of patients utilizing CPAP for OSA. Stimulants were used in OSA independently of CPAP use, with almost half of patients with OSA not receiving CPAP. Amphetamines/methylphenidate were used almost twice as often as modafinil/armodafinil in OSA. Limitations of this research include the retrospective study design, lack of confirmed prescribing indications for medication claims, and potential bias related to sampling error.
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