title: The Association between Insomnia and Insomnia Treatment Side Effects on Health Status, Work Productivity, and Healthcare Resource Use.
abstract: The aims of this study were (1) to compare health outcomes (i.e., health-related quality of life [HRQoL], productivity at work, and healthcare resource use visits) between those with insomnia and non-insomnia controls, (2) to compare health outcomes between those treated for insomnia and non-insomnia controls, and (3) to assess the prevalence of side effects of insomnia medications and their relationship with health outcomes. Data from the 2013 US (N = 75,000) and 5EU (N = 62,000) National Health and Wellness Survey (NHWS) were used. The NHWS is a patient-reported survey administered to a demographically representative sample of adults. Those who met DSM-V criteria for insomnia and, separately, those treated for insomnia were compared with equivalently sized control groups who were identified using a propensity score matching method. Outcomes included HRQoL (Short Form 36v2), productivity at work (Work Productivity and Activity Impairment-General Health questionnaire), and healthcare resource use visits in the past 6 months and were analyzed using one-way ANOVAs. Among those with treated insomnia, those with and without side effects were compared on health outcomes using general linear models controlling for confounding variables. Patients with insomnia (n = 4147) and treated insomnia (n = 2860) in the 5EU reported significantly worse HRQoL than controls (health utilities: 0.60 vs. 0.74; 0.60 vs. 0.74, respectively), greater overall work impairment (38.74% vs. 14.86%; 39.50% vs. 15.66%), and more physician visits in the past 6 months (9.10 vs. 4.08; 9.58 vs. 4.11). Similar findings were observed in the US. Among those treated for insomnia, 13.56% and 24.55% in the US and 5EU, respectively, were non-adherent due to side effects. In the US, non-adherence was associated with significantly worse HRQoL (health utilities: 0.60 vs. 0.64, p <.05) and greater overall work impairment (37.71% vs. 29.08%, p <.05), among other significant differences. These relationships were not significant in the 5EU. A significant burden of insomnia was observed in both the US and 5EU, and the association remained even after treatment. Non-adherence due to side effects was common and, in the case of the US, associated with significantly poorer health outcomes.
authors.affiliation: Kantar Health, New York, New York, United States of America.
authors.forename: Marco
authors.initials: M
authors.lastname: DiBonaventura
authors.affiliation: Eisai Europe Ltd, Hatfield, United Kingdom.
authors.forename: Lance
authors.initials: L
authors.lastname: Richard
authors.affiliation: Kantar Health, New York, New York, United States of America.
authors.forename: Maya
authors.initials: M
authors.lastname: Kumar
authors.affiliation: Eisai Inc., Woodcliff Lake, New Jersey, United States of America.
authors.forename: Anna
authors.initials: A
authors.lastname: Forsythe
authors.affiliation: Kantar Health, New York, New York, United States of America.
authors.forename: Natalia M
authors.initials: NM
authors.lastname: Flores
authors.affiliation: Eisai Inc., Woodcliff Lake, New Jersey, United States of America.
authors.forename: Margaret
authors.initials: M
authors.lastname: Moline
mesh_terms: D000328:Adult; D039721:Diagnostic and Statistical Manual of Mental Disorders; D064420:Drug-Related Side Effects and Adverse Reactions; D004526:Efficiency; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000628:therapy*; D011795:Surveys and Questionnaires; D016903:Drug Monitoring