title: Will insomnia treatments produce overall cost savings to commercial managed-care plans? A predictive analysis in the United States.
abstract: OBJECTIVE
  Research indicates that insomnia may contribute significantly to healthcare costs; however, information on the effects of treatments on costs has not been thoroughly published. This study presents predictive models that forecast, from the perspective of commercial managed care, the effects of insomnia medications in reducing overall medical costs. The main objectives of this study were to predict the level of cost savings associated with insomnia treatments, illustrate the variation in outcomes given underlying model assumptions, and assist managed-care policy-makers with the evaluation of medications routinely administered for insomnia.
  
  
  METHODS
  Data on four primary-efficacy measures: wake after sleep onset (WASO), sleep efficiency (SE), sleep onset latency (SOL) and total sleep time (TST) were abstracted from published clinical trial data for eszopiclone, indiplon, low-dose trazodone, ramelteon, zaleplon, zolpidem and zolpidem extended-release. Change in per-patient per-year (PPPY) healthcare costs in a single claims database was calculated for subjects taking zolpidem, zaleplon and low-dose trazodone using generalized linear model (GLM) techniques, controlling for baseline demographics and baseline costs. Change in costs for emerging insomnia medications was forecasted by imputing efficacy values for these drugs into the regressions.
  
  
  RESULTS
  Using the accepted efficacy measure, WASO, zolpidem extended-release had the overall forecasted savings of -$1253 (CI: -$1404 to -$1404) PPPY compared to remaining treatments, whereas ramelteon cost an additional $348 (-$1280 to $584) PPPY. In three out of four cost-efficacy models, zolpidem extended-release had higher mean forecasted PPPY savings.
  
  
  CONCLUSIONS
  This study examined cost effects of existing and emerging insomnia medications using models integrating clinical literature and medical claims within a statistical framework. The use of a single database may limit generalizability and models only address a 1-year period. Results suggest treatments can offer health plans direct cost savings, with amounts sensitive to variable and efficacy measures, potentially limited by those variables available in the claims database. Compared to other evaluated treatments, zolpidem extended-release produced consistently higher predicted cost savings.
authors.affiliation: Rutgers Pharmacoeconomics and Health Outcomes Fellow, Piscataway, NJ, USA.
authors.forename: M
authors.initials: M
authors.lastname: Jhaveri
authors.forename: B
authors.initials: B
authors.lastname: Seal
authors.forename: M
authors.initials: M
authors.lastname: Pollack
authors.forename: D
authors.initials: D
authors.lastname: Wertz
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D003362:Cost-Benefit Analysis; D003692:Delayed-Action Preparations; D005260:Female; D005544:Forecasting; D017048:Health Care Costs; D006801:Humans; D006993:Hypnotics and Sedatives / Q000191:economics* / Q000627:therapeutic use*; D008297:Male; D008329:Managed Care Programs / Q000191:economics*; D008875:Middle Aged; D011725:Pyridines / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D012890:Sleep / Q000187:drug effects; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy* / Q000191:economics*; D016896:Treatment Outcome; D014481:United States; D000077334:Zolpidem
chemical_list: D003692:Delayed-Action Preparations; D006993:Hypnotics and Sedatives; D011725:Pyridines; D000077334:Zolpidem