Prevalence and cost of insomnia in a state Medicaid fee-for-service population based on diagnostic codes and prescription utilization

Roy, Anuja; Smith, Michael J.

doi:10.1016/j.sleep.2009.09.012

Cited by 31 publications

(22 citation statements)

References 27 publications

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“…Compared to good sleepers, individuals with insomnia have more visits to general practitioners and medical specialists, twice as many hospitalizations, and use more medications than good sleepers. 7,8 The common co-occurrence of insomnia with other conditions is an important consideration when examining HCU and associated costs as the rates of insomnia occurring in the context of other common medical and psychiatric conditions are much higher than that in the general population. 9,10 For example, an epidemiological study revealed that approximately 38% of individuals with a comorbid condition exhibited insomnia compared to only 8% of individuals without a comorbid condition.…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

“…One study found that among Medicaid claims, the majority of the cost of insomnia treatment was for prescription drugs, with zolpidem and trazodone the most prescribed medications. 8 Pharmacotherapy is the most common approach to treating insomnia 13 ; to date, at least two studies have examined its impact on health care costs with mixed results. Jhaveri et al demonstrated that several pharmacological interventions for insomnia (e.g., eszopiclone, indiplon, ramelteon, low-dose trazodone, zaleplon, zolpidem, and zolpidem extended-release) produced sizeable yet variable cost savings when accounting for sleep onset latency, wake after sleep onset, and sleep efficiency.…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

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Impact of Brief Cognitive Behavioral Treatment for Insomnia on Health Care Utilization and Costs

McCrae

Bramoweth

Williams

et al. 2014

Journal of Clinical Sleep Medicine

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Study Objectives: To examine health care utilization (HCU) and costs following brief cognitive behavioral treatment for insomnia (bCBTi). Methods: Reviewed medical records of 84 outpatients [mean age = 54.25 years (19.08); 58% women] treated in a behavioral sleep medicine clinic (2005)(2006)(2007)(2008)(2009)(2010) based in an accredited sleep disorders center. Six indicators of HCU and costs were obtained: estimated total and outpatient costs, estimated primary care visits, CPT costs, number of office visits, and number of medications. All patients completed ≥ 1 session of bCBTi. Those who attended ≥ 3 sessions were considered completers (n = 37), and completers with significant sleep improvements were considered responders (n = 32). Results: For completers and responders, all HCU and cost variables, except number of medications, signifi cantly decreased (ps < 0.05) or trended towards decrease at posttreatment. Completers had average decreases in CPT costs of $200 and estimated total costs of $75. Responders had average decreases in CPT costs of $210. No signifi cant decreases occurred for non-completers. Conclusions: bCBTi can reduce HCU and costs. Response to bCBTi resulted in greater reduction of HCU and costs. While limited by small sample size and non-normal data distribution, the fi ndings highlight the need for greater dissemination of bCBTi for several reasons: a high percentage of completers responded to treatment, as few as 3 sessions can result in signifi cant improvements in insomnia severity, bCBTi can be delivered by novice clinicians, and health care costs can reduce following treatment. Insomnia remains an undertreated disorder, and brief behavioral treatments can help to increase access to care and reduce the burden of insomnia. Keywords: Insomnia, health care utilization, costs, brief cognitive behavioral treatment, physician visits, medication Citation: McCrae CS; Bramoweth AD; Williams J; Roth A; Mosti C. Impact of brief cognitive behavioral treatment for insomnia on health care utilization and costs. J Clin Sleep Med 2014;10(2):127-135.http://dx.doi.org/10.5664/jcsm.3436 S C I E N T I F I C I N V E S T I G A T I O N SC hronic insomnia impacts approximately 8% to 10% of adults in the United States population 1 and carries substantial economic burden. Direct costs (i.e., costs directly related to treatment) have been estimated at $13.9 billion annually in the United States, with total treatment costs estimated at $77 to $92 billion. 2 When indirect costs (i.e., lost productivity, insomniarelated accidents, increased medical problems) are included, annual costs exceed $100 billion. 3 Evidence from outside the U.S. reveals a similar pattern. Specifi cally, a study in Quebec, Canada, found that the combined direct and indirect per-person costs of insomnia syndrome (insomnia complaint ≥ 3 nights/ week with > 1 month duration, dissatisfaction with sleep, and daytime impairment; prescription sleep medication ≥ 3 nights/ week) was approximately $5,010; with $293 attributed to direct costs and $4,717...

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Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

Impact of Brief Cognitive Behavioral Treatment for Insomnia on Health Care Utilization and Costs

McCrae

Bramoweth

Williams

et al. 2014

Journal of Clinical Sleep Medicine

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“…30 The West Virginia Medicaid program database indicated that in 2003, zolpidem represented 43% of claims, trazodone 46%, temazepam 10%, and triazolam, flurazepam, estazolam, and zaleplon less than 2%. 31 In Norway, a study found higher rates of zopiclone then zolpidem in drivers, reflecting the prescribing bias of the physicians in that country. 8 It is important to note that no study has prospectively studied the propensity for any hypnotic sedative to trigger a parasomnia.…”

Section: Legal Case 4 April 2009mentioning

confidence: 99%

Zolpidem Ingestion, Automatisms, and Sleep Driving: A Clinical and Legal Case Series

Poceta

2011

Journal of Clinical Sleep Medicine

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study Objectives: To describe zolpidem-associated complex behaviors, including both daytime automatisms and sleeprelated parasomnias. Methods: A case series of eight clinical patients and six legal defendants is presented. Patients presented to the author after an episode of confusion, amnesia, or somnambulism. Legal defendants were being prosecuted for driving under the infl uence, and the author reviewed the cases as expert witness for the defense. Potential predisposing factors including comorbidities, social situation, physician instruction, concomitant medications, and patterns of medication management were considered. Results: Patients and defendants exhibited abnormal behavior characterized by poor motor control and confusion. Although remaining apparently interactive with the environment, all reported amnesia for 3 to 5 hours. In some cases, the episodes began during daytime wakefulness because of accidental or purposeful ingestion of the zolpidem and are considered automatisms. Other cases began after ingestion of zolpidem at the time of going to bed and are considered parasomnias. Risk factors for both wake and sleep-related automatic complex behaviors include the concomitant ingestion of other sedating drugs, a higher dose of zolpidem, a history of parasomnia, ingestion at times other than bedtime or when sleep is unlikely, poor management of pill bottles, and living alone. In addition, similar size and shape of two medications contributed to accidental ingestion in at least one case. Conclusions s C i e n T i F i C i n V e s T i g a T i O n sT he ingestion of zolpidem and other hypnotic sedative medications for the treatment of insomnia has been associated with sleepwalking and other complex behaviors including sleep eating and sleep driving.1-5 When ingested during the daytime, hypnotic sedatives impair cognition, memory, and motor performance. 6 There are also reports of a high frequency of blood levels of hypnotic sedatives in drivers apprehended for driving under the infl uence (DUI).7-9 An advisory letter was sent and change in package insert information occurred on March 14, 2007, alerting physicians and the public to the possibility of complex behaviors with all hypnotic sedatives.According to the prescribing information for Ambien and Ambien CR, zolpidem is an imidazopyridine chemical class agent available in the US since 1992. It is chemically unrelated to benzodiazepine and barbiturate hypnotic sedatives. Zolpidem in vitro binds the BZ1 receptor of the GABA(A) complex with high affi nity ratio for the alpha1/alpha5 subunits. Mean peak concentrations were 59 (range 29 to 113) after ingestion of the 5 mg tablet and 121 (range 58 to 272) after ingestion of the 10 mg tablet (ng/mL). Time to maximum concentration was 1.6 h for both doses (but 2.2 h if taken with food) with a half-life of approximately 2.6 h (range 1.4 to 4.5) The zolpidem extended release formulation 12.5 mg tablets produced a maximum concentration of 134 (69 to 197) at 1.5 hours. Co-administration with fl uoxetine increased ha...

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“…In an analysis of West Virginia Medicaid data from 2003 regarding prescription hypnotic agents (including off-label use of the antidepressant trazodone), the benzodiazepines accounted for almost 11% of claims filed (estazolam 0.4%, flurazepam 0.1%, temazepam 10%, and triazolam 0.3%) [11]. In contrast, zolpidem accounted for 42.7% of claims, zaleplon 1%, and trazodone 45.5%.…”

Section: Contemporary Treatment Of Insomniamentioning

confidence: 99%

Managing insomnia: an overview of insomnia and pharmacologic treatment strategies in use and on the horizon

Schwartz¹,

Goradia²

2013

DIC

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This review explores basic sleep physiology, the mechanism of action for each class of hypnotic agents, their clinical application based on pharmacodynamic and pharmacokinetic factors, and potential pharmacologic sleep-inducing mechanisms of future hypnotics. The paper challenges the reader to understand the neuroscientific basis of insomnia and use this knowledge to guide prescription of hypnotic agents.Currently indicated hypnotic agents are discussed with regard to their mechanism of drug action and clinical application. A broader discussion is developed throughout this paper regarding other non-indicated agents that may improve sleep and describing newer pharmacological treatments that may become available in the future for use in sleep disorders and their comorbid conditions.

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Prevalence and cost of insomnia in a state Medicaid fee-for-service population based on diagnostic codes and prescription utilization

Cited by 31 publications

References 27 publications

Impact of Brief Cognitive Behavioral Treatment for Insomnia on Health Care Utilization and Costs

Impact of Brief Cognitive Behavioral Treatment for Insomnia on Health Care Utilization and Costs

Zolpidem Ingestion, Automatisms, and Sleep Driving: A Clinical and Legal Case Series

Managing insomnia: an overview of insomnia and pharmacologic treatment strategies in use and on the horizon

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