title: Financial incentive increases CPAP acceptance in patients from low socioeconomic background.
abstract: OBJECTIVE
  We explored whether financial incentives have a role in patients' decisions to accept (purchase) a continuous positive airway pressure (CPAP) device in a healthcare system that requires cost sharing.
  
  
  METHODS
  Longitudinal interventional study.
  
  
  METHODS
  The group receiving financial incentive (n = 137, 50.8±10.6 years, apnea/hypopnea index (AHI) 38.7±19.9 events/hr) and the control group (n = 121, 50.9±10.3 years, AHI 39.9±22) underwent attendant titration and a two-week adaptation to CPAP. Patients in the control group had a co-payment of $330-660; the financial incentive group paid a subsidized price of $55.
  
  
  RESULTS
  CPAP acceptance was 43% greater (p = 0.02) in the financial incentive group. CPAP acceptance among the low socioeconomic strata (n = 113) (adjusting for age, gender, BMI, tobacco smoking) was enhanced by financial incentive (OR, 95% CI) (3.43, 1.09-10.85), age (1.1, 1.03-1.17), AHI (>30 vs. <30) (4.87, 1.56-15.2), and by family/friends who had positive experience with CPAP (4.29, 1.05-17.51). Among average/high-income patients (n = 145) CPAP acceptance was affected by AHI (>30 vs. <30) (3.16, 1.14-8.75), living with a partner (8.82, 1.03-75.8) but not by the financial incentive. At one-year follow-up CPAP adherence was similar in the financial incentive and control groups, 35% and 39%, respectively (p = 0.82). Adherence rate was sensitive to education (+yr) (1.28, 1.06-1.55) and AHI (>30 vs. <30) (5.25, 1.34-18.5).
  
  
  CONCLUSIONS
  Minimizing cost sharing reduces a barrier for CPAP acceptance among low socioeconomic status patients. Thus, financial incentive should be applied as a policy to encourage CPAP treatment, especially among low socioeconomic strata patients.
authors.affiliation: Sleep-Wake Disorders Unit, Faculty of Health Sciences, Department of Physiology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel. tarasiuk@bgu.ac.il
authors.forename: Ariel
authors.initials: A
authors.lastname: Tarasiuk
authors.forename: Gally
authors.initials: G
authors.lastname: Reznor
authors.forename: Sari
authors.initials: S
authors.lastname: Greenberg-Dotan
authors.forename: Haim
authors.initials: H
authors.lastname: Reuveni
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D045422:Continuous Positive Airway Pressure / Q000191:economics* / Q000706:statistics & numerical data*; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D020181:Sleep Apnea, Obstructive / Q000523:psychology / Q000628:therapy*; D012923:Social Class; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult