Cost-effectiveness analysis of lemborexant for treating insomnia in Japan: a model-based projection, incorporating the risk of falls, motor vehicle collisions, and workplace accidents

Abstract

Background Lemborexant has demonstrated statistically significant improvements in sleep onset and sleep maintenance compared with placebo and zolpidem tartrate extended release, measured both objectively using polysomnography and subjectively using sleep diaries, in the phase 3 clinical trial SUNRISE 1. This study evaluated the cost-effectiveness of lemborexant compared with suvorexant, zolpidem immediate release (IR), and untreated insomnia. Methods A decision-tree model was developed for falls, motor vehicle collisions, and workplace accidents associated with insomnia and insomnia treatments from a Japanese healthcare perspective and with a 6-month time horizon. The model extracted subjective sleep onset latency treatment responses and disutility values for non-responders from SUNRISE 1. Cost-effectiveness was assessed using incremental cost per quality-adjusted life year (QALY) gained. One-way and probabilistic sensitivity analyses were conducted to evaluate the impact of parameter uncertainty on the results. Results In the base-case analysis, the mean estimated QALYs for lemborexant, suvorexant, zolpidem-IR, and untreated insomnia were 0.4220, 0.4204, 0.4113, and 0.4163, and expected medical costs were JPY 34 034, JPY 38 371, JPY 38 139, and JPY 15 383, respectively. Lemborexant saved JPY 4337 and JPY 4105 compared with suvorexant or zolpidem-IR, respectively, while conferring QALY benefits. The incremental cost-effectiveness ratio (ICER) of lemborexant compared with that of untreated insomnia was JPY 3 220 975 /QALY. Lemborexant was dominant over suvorexant and zolpidem-IR and was cost-effective when compared with untreated insomnia. Sensitivity analyses supported the results' robustness. Conclusions In a Japanese clinical practice setting, lemborexant may represent a better investment for treating insomnia in the healthcare system in Japan.

Content Comparison of Quality-of-Life Instruments Used in Economic Evaluations of Sleep Disorder Interventions: A Systematic Review

“…One retrospective case-crossover [ 64 ] and one cohort study [ 63 ] ran economic evaluations concurrently. Twenty-five studies were model based, 14 using a Markov model [ 53 , 56 , 65 , 67 – 71 , 73 , 75 , 77 , 78 , 80 , 98 ], five using a decision-tree model [ 74 , 104 – 107 ], one using both Markov and decision-tree models [ 76 ], one using a semi-Markov model [ 79 ] and one using a decision analytic model [ 81 ]. Additionally, two studies used randomised controlled trial-based modelling [ 94 , 108 ], and one used a case-control-based model [ 72 ].…”

“…The included studies were conducted mainly in the UK ( n = 12) [ 35 , 60 – 62 , 65 , 66 , 70 – 73 , 93 , 97 ], USA ( n = 11) [ 74 , 75 , 78 , 79 , 90 , 94 , 98 , 100 , 106 , 108 , 110 ] and Spain ( n = 10) [ 53 – 58 , 64 , 82 , 83 , 89 ]. Japan [ 76 , 92 , 104 , 105 ] and Canada [ 68 , 77 , 80 , 101 ] each had four studies, The Netherlands had three studies [ 59 , 95 , 99 ], and Germany [ 96 , 102 ] and France [ 69 , 85 ] had two studies each. Single studies were conducted in Colombia [ 67 ], New Zealand [ 107 ], South Korea [ 103 ], Finland [ 63 ], Australia [ 84 ] and Hong Kong [ 91 ].…”

Physicians’ attitudes toward hypnotics for insomnia: A questionnaire-based study

“…The result is understandable because the highest drug price for hypnotics was that of lemborexant, followed by suvorexant at the time of this study. Although ORA drug prices are indeed high, a previous study conducted in Japan showed that lemborexant was superior to zolpidem in terms of cost-effectiveness ( 14 ). Therefore, many physicians may prescribe ORAs frequently because of their efficacy and safety despite the high cost of ORA.…”

The mediating effect of resilience and COVID-19 anxiety on the relationship between social support and insomnia among healthcare workers: a cross-sectional study

“…Insomnia relates to a number of illnesses, such as hypertension, diabetes, stroke, and chronic kidney illness ( 12 ). Also, insomnia relates to accidents on the road, workplace, and home ( 13 , 14 ). As a significant predictor for anxiety and depression, insomnia has bidirectional effects on anxiety and depression ( 15 , 16 ).…”