A study in the Oct. 15 issue of the Journal of Clinical Sleep Medicine explored the cost-effectiveness of the current Medicare CPAP coverage policy. Medicare restricts long-term CPAP coverage to those demonstrating adherence during a 90-day trial period and, when the trial fails, requires a repeat in-lab sleep study to authorize another 90-day trial to continue coverage. An analytical model compared this policy with a theoretical 13-month CPAP trial period during which CPAP coverage would continue as long as beneficiaries followed up in clinic every three months.
Results of sensitivity analyses show that the current Medicare policy yields greater overall CPAP adherence rates and improves quality of life but at a higher cost. The model suggests that the CMS policy leads to a difference of about 11 percent in net long-term adherence rates with an incremental cost of about $2,000 per percent-adherence-gained over 5 years. According to the authors, other incentive strategies to improve adherence may be able to produce a similar effect but with less cost to CMS.
