5/7/2021 Understanding the Economic Burden of Insomnia Treatment in Patients With Comorbid Conditions

Understanding the Economic Burden of

Insomnia Treatment in Patients With Comorbid
Conditions
May 5, 2021
Laura Joszt

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 rst 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
ll 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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