Investigating the Incremental Cost and Utilization Burden of Obstructive Sleep Apnea in Overweight to Severely Obese...

To quantify the incremental economic and utilization burden of comorbid obstructive sleep apnea (OSA) within an overweight to severely obese adult population.

This retrospective cohort study utilized 2016-2025 IQVIA PharMetrics Plus Closed Health Plan commercial claims data to identify overweight to severely obese adults aged 18-64 years. Patients with diagnosed OSA were propensity-score matched 1:1 to non-OSA controls. Generalized linear models were constructed to quantify the incremental burden of OSA through adjusted cost/rate ratios and average marginal effects (AMEs) over a 365-day follow up period. Outcomes were also stratified by obesity severity, cardiovascular disease (CVD), diabetes, sex, and baseline glucagon-like peptide-1 receptor agonist (GLP-1 RA) use.

Among OSA patients, 13 971 (99.9%) were successfully matched (total n = 27 942). Patients with OSA incurred significantly higher total healthcare costs compared to controls (adjusted cost ratio = 1.24; 95% CI = [1.20, 1.28]), corresponding to an AME of $6942 per patient. Costs were driven by routine disease management such as outpatient visits (AME = $2955) and prescription costs (AME = $3198). Subgroup analyses revealed that incremental costs were high among patients with CVD (AME = $9257) and notably, the incremental cost of OSA remained substantial even among chronic users of GLP-1 RAs (AME = $12359).

Comorbid OSA is associated with a significant increase in total healthcare costs driven largely by outpatient and prescription costs. This burden was concentrated among patients with cardiovascular comorbidity and persisted among chronic GLP-1 RA users.