title: Healthcare costs among patients with excessive sleepiness associated with obstructive sleep apnea, shift work disorder, or narcolepsy.
abstract: BACKGROUND
  Excessive daytime sleepiness affects nearly 20% of the general population and is associated with many medical conditions, including shift work disorder (SWD), obstructive sleep apnea (OSA), and narcolepsy. Excessive sleepiness imposes a significant clinical, quality-of-life, safety, and economic burden on society.
  
  
  OBJECTIVE
  To compare healthcare costs for patients receiving initial therapy with armodafinil or with modafinil for the treatment of excessive sleepiness associated with OSA, SWD, or narcolepsy.
  
  
  METHODS
  A retrospective cohort analysis of medical and pharmacy claims was conducted using the IMS LifeLink Health Plan Claims Database. Patients aged ≥18 years who had a pharmacy claim for armodafinil or for modafinil between June 1, 2009, and February 28, 2012, and had 6 months of continuous eligibility before the index prescription date, as well as International Classification of Diseases, Ninth Revision diagnosis for either OSA (327.23), SWD (327.36), or narcolepsy (347.0x) were included in the study. Patients were placed into 1 of 2 treatment cohorts based on their index prescription and followed for 1 month minimum and 34 months maximum. The annualized all-cause costs were calculated by multiplying the average per-month medical and pharmacy costs for each patient by 12 months. The daily average consumption (DACON) for armodafinil or for modafinil was calculated by dividing the total units dispensed of either drug by the prescription days supply.
  
  
  RESULTS
  A total of 5693 patients receiving armodafinil and 9212 patients receiving modafinil were included in this study. A lower DACON was observed for armodafinil (1.04) compared with modafinil (1.47). The postindex mean medical costs were significantly lower for the armodafinil cohort compared with the modafinil cohort after adjusting for baseline differences ($11,363 vs $13,775, respectively; P = .005). The mean monthly drug-specific pharmacy costs were lower for the armodafinil cohort compared with the modafinil cohort ($166 vs $326, respectively; P <.001). In addition, lower total healthcare costs were observed for the armodafinil cohort compared with the modafinil cohort after correcting for baseline differences ($18,309 vs $23,530, respectively; P <.001).
  
  
  CONCLUSIONS
  As shown in this analysis, armodafinil may have real-world DACON advantages and may be associated with lower overall healthcare costs compared with modafinil.
authors.affiliation: Assistant Director, Global Health Economics and Outcomes Research, Xcenda, Palm Harbor, FL.
authors.forename: Rashad
authors.initials: R
authors.lastname: Carlton
authors.affiliation: Associate Director, Applied Data Analytics, Xcenda, Palm Harbor, FL.
authors.forename: Orsolya
authors.initials: O
authors.lastname: Lunacsek
authors.affiliation: Executive Director, Strategic Accounts, Xcenda, Palm Harbor, FL.
authors.forename: Timothy
authors.initials: T
authors.lastname: Regan
authors.affiliation: Senior Director, Market Access, Xcenda, Palm Harbor, FL.
authors.forename: Cathryn A
authors.initials: CA
authors.lastname: Carroll