Chest
Clinical InvestigationsDeterminants Affecting Health-Care Utilization in Obstructive Sleep Apnea Syndrome Patients
Section snippets
Materials and Methods
Subjects are enrollees of Clalit Health Care Services (CHS), the largest health maintenance organization in Israel; all had been permanent residents of the southern region for at least 3 years prior to study initiation. Recruited subjects are “typical” OSAS patients (with or without chronic diseases and prescribed medication respectively) and control subjects, entitled to a polysomnographic study and all diagnostic and treatment information free of charge. Control subjects (n = 218) randomly
Data Analysis
Cost data were analyzed18 using statistical software (SPSS version 11.5; SPSS; Chicago, IL). Statistical power (α = 0.05) was calculated for the women (n = 44, control vs OSAS) and was found to be 0.98. One-way analysis of variance was used to compare between mean values. A Mann-Whitney U test was used to determine statistical significance of cost elements between groups; χ2 was used to confirm “population match” and univariate analysis. Multivariate logistic regression analysis was used to
Results
Two hundred eighteen adult OSAS patients were included (mean age, 54.8 ± 10.3 years; 18% >65 years old; 79.8% male gender). The control subjects were perfectly matched (χ2 = 0.999) by family physician, age, gender, and address. All symptoms were typical for the OSAS group except for “observed choking” by the spouse, which was reported in 47% of the men vs 25% of women (p < 0.01). The comorbidity of the OSAS group (hypertension, 40.5%; diabetes mellitus, 14.5%; pulmonary diseases, 12.4%) was
Discussion
OSAS patients consumed 1.7-fold more health-care resources than control subjects. The present study describes cost elements previously described in children15, 16 for “typical” adults with OSAS in a health-care system in which all citizens are entitled by law to free access to medical care. Our data on health-care utilization may be difficult to compare with those from other health-care systems that have more than one payer. These data can be compared to similar health-care systems as in
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