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Understanding the Economic Burden of Insomnia Treatment in Patients With Comorbid Conditions


Treating insomnia with commonly prescribed, older generation medications increases health care resource utilization and costs in patients with comorbid conditions.

Two posters presented at the Academy of Managed Care Pharmacy annual meeting evaluated health care resource utilization (HCRU) among adult patients taking insomnia medications.

The first poster looked at adult patients with hypertension and comorbid insomnia who were treated with older generation insomnia medications. These patients were compared with a matched cohort with hypertension and no sleep disorders.

The researchers used the IBM MarketScan Commercial and Medicare Supplemental Databases to identify eligible patients for the retrospective cohort study. Eligible patients had one or more prescriptions for zolpidem immediate release (IR), zolpidem extended release (ER), trazodone, or benzodiazepines.

They matched 81,502 patients with hypertension and insomnia (H+I) with the control cohort. The H+I patients had higher adjusted odds of emergency department (ED) visits, outpatient visits, and non-insomnia prescription drug use within 12 months of their earliest fill date for an insomnia medication. H+I patients had longer inpatient stays, although they did not have higher odds of inpatient visits, particularly for patients with trazodone, benzodiazepines, or zolpidem IR.

Adjusted total costs per patient per month (PPPM) for the H+I patients was higher relative to the matched cohort ($2,343 vs $1,013). Costs for outpatient, pharmacy, and the ED were higher for almost all H+I patients compared with the matched cohorts. H+I patients taking zolpidem ER were the only H+I patients who did not have higher inpatient costs compared with the control group.

“Results suggest differences by medication class and/or mechanism that warrant further research on the impact associated with newer dual orexin receptor antagonists,” the authors concluded.

The second poster, from the same authors and using the same databases, evaluated HCRU and costs associated with insomnia and the same older generation insomnia drugs in adult patients with depression. The 21,027 patients with depression and insomnia (D+I) were matched 1:1 with a control cohort with depression but no sleep disorders.

While the D+I patients in general had higher adjusted odds of ED visits, outpatient visits, and non-insomnia prescription drug use compared with the control, the mean length of stay was not longer for patients prescribed zolpidem ER. Adjusted total costs PPPM were $2,450 for D+I patients compared with $1,095 for the matched controls.

For both posters, the authors noted that since insomnia is underreported or underdiagnosed, some patients with insomnia may have been missed, and that the results may not be generalizable to a non–commercially insured population. For the second poster, the authors noted that a limitation of the study was that it did not control for whether depression was treated.

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