Economic aspects of insomnia medication treatment among Medicare beneficiaries

Abstract

Study Objectives To examine economic aspects of insomnia and insomnia medication treatment among a nationally representative sample of older adult Medicare beneficiaries. Methods Using a random 5% sample of Medicare administrative data (2006–2013), insomnia was defined using International Classification of Disease, Version 9, Clinical Modification diagnostic codes. Treatment was operationalized as one or more prescription fills for an US Food and Drug Administration (FDA)-approved insomnia medication following diagnosis, in previously untreated individuals. To evaluate the economic impact of insomnia treatment on healthcare utilization (HCU) and costs in the year following insomnia diagnosis, a difference-in-differences approach was implemented using generalized linear models. Results A total of 23 079 beneficiaries with insomnia (M age = 71.7 years) were included. Of these, 5154 (22%) received one or more fills for an FDA-approved insomnia medication following insomnia diagnosis. For both treated and untreated individuals, HCU and costs increased during the 12 months prior to diagnosis. Insomnia treatment was associated with significantly increased emergency department visits and prescription fills in the year following insomnia diagnosis. After accounting for pre-diagnosis differences between groups, no significant differences in pre- to post-diagnosis costs were observed between treated and untreated individuals. Conclusions These results advance previous research into economics of insomnia disorder by evaluating the impact of medication treatment and highlighting important differences between treated and untreated individuals. Future studies should seek to understand why some individuals diagnosed with insomnia receive treatment but others do not, to identify clinically meaningful clusters of older adults with insomnia, and to explore the economic impact of insomnia and insomnia treatment among subgroups of individuals with insomnia, such as those with cardiovascular diseases, mood disorders, and neurodegenerative disease.

Incremental Healthcare Utilization and Cost Burden of Comorbid Insomnia in Alzheimer’s Disease Patients

“…Patients included in this study were on average 82 years old, which is similar to other claims-based studies of newly-diagnosed AD [20][21][22]. However, a higher percentage were female (67% versus 53%-63%) [21][22][23][24], which may reflect the higher prevalence of insomnia among women, as found in other studies [8,25]. In addition to being more common, some research suggests that in women insomnia presents in more complex ways with more symptoms [26] and that the adverse effects of insomnia and sleep loss are more severe among women compared to men with regards to cardiovascular health [27,28], risk of diabetes [28], and psychological affect, functioning, and quality of life [28,29].…”

Falls, healthcare resources and costs in older adults with insomnia treated with zolpidem, trazodone, or benzodiazepines

“…Inpatient costs, followed by outpatient costs, were the primary drivers of total costs both pre- and post-insomnia diagnosis, in both treated and untreated cohorts. Surprisingly, this previous Medicare analysis showed no significant difference in total costs between the treated and untreated cohorts during the 12 months prior and 12 months post-insomnia diagnosis [ 42 ]. In another study, relative to non-sleep disordered controls, patients with untreated insomnia demonstrated $63,607 (95% CI: $60,532, $66,685) higher all-cause healthcare utilization and costs in the 11 months prior to insomnia diagnosis or matched index date, with inpatient care accounting for most of the healthcare use and costs (2019 USD) [ 43 ].…”

Changes in Healthcare Resource Use and Costs in Commercially Insured Insomnia Patients Initiating Suvorexant

“…Further, slope changes suggested that prescription costs continued to decrease afterward. While prior claims database analyses assessing real-world economic outcomes in patients with insomnia exist [23][24][25][26], none have yet Fig. 4 Trend over time for monthly total healthcare costs and medical costs (2018 US dollars) before and after initiation of suvorexant for a prevalent insomnia cohort and b incident insomnia cohort.…”