Introduction

Insomnia diagnosis has been associated with a significant clinical and economic burden on patients and healthcare systems. This study examined changes in healthcare resource use (HCRU) and costs in insomnia patients before and after initiation of suvorexant treatment.

Methods

This retrospective cohort study analyzed Optum Clinformatics Data Mart claims data (Jan 2010–Dec 2018). Patients with ≥ 2 insomnia diagnosis claims and ≥ 1 prescription for suvorexant were included. Prevalent and incident insomnia patients were analyzed separately. The change in the trends of HCRU and costs were examined for 12 months before and 12 months after suvorexant initiation. An interrupted time series (ITS) analysis was conducted to assess the level and slope changes. Subgroups of patients with mental health comorbidities were examined.

Results

The study included 18,919 and 5939 patients in the prevalent and incident insomnia cohorts, respectively. For the prevalent cohort, mean (SD) age was 64.5 (14.1) years, 65% were female, 74% had Medicare Advantage coverage, and 61% had a Charlson comorbidity index score ≥ 1. Characteristics for the incident cohort were similar. The ITS results suggested that the trend for monthly total healthcare cost (THC) was increasing before suvorexant initiation (US$52.51 in the prevalent cohort, $74.93 in incident insomnia cohort), but, after suvorexant initiation, the monthly total cost showed a decreasing trend in both cohorts. The decrease in slope for THC after suvorexant initiation were $72.66 and $112.07 per month in the prevalent and incident cohorts, respectively. The monthly trends in HCRU rates also decreased. The subgroup analysis showed that decreases were 1.5–3 times greater for patients with mental health comorbidities.

Conclusions

In this real-world study, suvorexant initiation was associated with immediate and continued decreases in HCRU and costs in insomnia patients. Further research is needed to understand the effect of suvorexant initiation on direct medical costs as well as costs associated with lost productivity in other real-world settings.

中文翻译：

---

启动 Suvorexant 的商业保险失眠患者医疗资源使用和成本的变化

介绍

失眠诊断与患者和医疗保健系统的重大临床和经济负担有关。本研究检查了失眠患者在开始 suvorexant 治疗之前和之后医疗资源使用 (HCRU) 和成本的变化。

方法

这项回顾性队列研究分析了 Optum Clinformatics Data Mart 索赔数据（2010 年 1 月至 2018 年 12 月）。纳入 ≥ 2 份失眠诊断声明和 ≥ 1 份 suvorexant 处方的患者。分别分析了失眠患者的患病率和发病率。在 suvorexant 开始前 12 个月和开始后 12 个月检查了 HCRU 和成本趋势的变化。进行间断时间序列 (ITS) 分析以评估水位和坡度变化。对患有精神健康合并症的患者亚组进行了检查。

结果

该研究分别包括流行和突发失眠队列中的 18,919 和 5939 名患者。对于流行队列，平均 (SD) 年龄为 64.5 (14.1) 岁，65% 为女性，74% 拥有 Medicare Advantage 覆盖率，61% 的 Charlson 合并症指数评分 ≥ 1。事件队列的特征相似。ITS 结果表明，在开始使用 suvorexant 之前，每月总医疗费用 (THC) 呈上升趋势（流行队列中为 52.51 美元，在失眠事件中为 74.93 美元），但在开始使用 suvorexant 后，每月总费用呈下降趋势两个队列。在流行组和事件组中，开始使用 suvorexant 后 THC 的斜率下降分别为每月 72.66 美元和 112.07 美元。HCRU 率的月度趋势也有所下降。

结论

在这项真实世界的研究中，suvorexant 启动与 HCRU 的立即和持续降低以及失眠患者的成本相关。需要进一步的研究来了解 suvorexant 启动对直接医疗成本的影响，以及与其他现实世界环境中生产力损失相关的成本。