title: Change in healthcare utilization and costs following initiation of benzodiazepine therapy for long-term treatment of generalized anxiety disorder: a retrospective cohort study.
abstract: BACKGROUND
  Selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and benzodiazepine anxiolytics are used in the US to treat generalized anxiety disorder (GAD). While benzodiazepines typically provide rapid symptomatic relief, long-term use is not recommended due to risks of dependency, sedation, falls, and accidents.
  
  
  METHODS
  Using a US health insurance database, we identified all persons with GAD (ICD-9-CM diagnosis code 300.02) who began a long-term course of treatment (≥ 90 days) with a benzodiazepine anxiolytic between 1/1/2003 and 12/31/2007, We compared healthcare utilization and costs over the six-month periods preceding and following the date of treatment initiation ("pretreatment" and "post-treatment", respectively), and focused attention on accident-related encounters (e.g., for treatment of fractures) and care received for other reasons possibly related benzodiazepine use (e.g., sedation, dizziness).
  
  
  RESULTS
  A total of 866 patients met all study entry criteria; 25% of patients began treatment on an add-on basis (i.e., adjunctive to escitalopram, paroxetine, sertraline, or venlafaxine), while 75% of patients did not receive concomitant therapy. Mean total healthcare costs increased by $2334 between the pretreatment and post-treatment periods (from $4637 [SD=$9840] to $6971 [$17,002]; p<0.01); costs of accident-related encounters and other care that was possibly related to use of benzodiazepines increased by an average of $1099 ($1757 [$7656] vs $2856 [$14,836]; p=0.03).
  
  
  CONCLUSIONS
  Healthcare costs increase in patients with GAD beginning long-term (≥ 90 days) treatment with a benzodiazepine anxiolytic; a substantial proportion of this increase is attributable to care associated with accidents and other known sequelae of long-term benzodiazepine use.
authors.affiliation: Policy Analysis Inc, (PAI), Brookline, MA, USA. aberger@pai2.com
authors.forename: Ariel
authors.initials: A
authors.lastname: Berger
authors.forename: John
authors.initials: J
authors.lastname: Edelsberg
authors.forename: Michael
authors.initials: M
authors.lastname: Treglia
authors.forename: Jose Ma J
authors.initials: JM
authors.lastname: Alvir
authors.forename: Gerry
authors.initials: G
authors.lastname: Oster
mesh_terms: D000328:Adult; D000368:Aged; D014151:Anti-Anxiety Agents / Q000191:economics / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000188:drug therapy* / Q000191:economics; D001569:Benzodiazepines / Q000191:economics / Q000627:therapeutic use*; D003695:Delivery of Health Care / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data*; D008134:Long-Term Care / Q000191:economics; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D014151:Anti-Anxiety Agents; D001569:Benzodiazepines