INTRODUCTION: Lack of adherence is the main challenge to Continuous Positive Airway Pressure (CPAP) effectiveness.

METHOD: A multicenter randomized controlled trial of PIMA (program based on patient stratification and personalized care plans to improve CPAP adherence) vs standard follow-up was conducted in Spain to evaluate the impact on adherence and quality of life. A health economic model was developed to estimate the clinical and economic outcomes of PIMA from the Spanish Healthcare system and societal perspectives.

RESULTS: 213 patients were randomized. Adherence was higher in the PIMA group compared to the control group at 90 days with a difference of 1.74 hours/day (95%CI: 1.18-2.30; p<0.0001) and at 180 days with a difference of 2.31 (95%CI: 1.72-2.91; p<0.001). The secondary endpoints on quality of life, emotional state, activities, social relationships, perceived competence and motivation showed significant differences in favor of the PIMA group. The health economic model simulation applied to the 775,850 patients treated by CPAP in Spain in 2021, estimated 32,260 cardiovascular events, 8,662 road traffic accidents and 1,274 occupational accidents avoided. This would mean an annual saving of ?186,734,338 in direct costs, ?13,043,828 in direct non-medical costs, and ?292,831,954 in indirect costs.

CONCLUSION: Widespread use of interventions to increase CPAP adherence such as PIMA, could represent a significant immediate health benefit to patients and substantial cost savings for the Healthcare System and society.