0387 Burden of insomnia among Alzheimer's patients: variations in comorbidities and healthcare utilization in Medicaid enrollees

Abstract

Abstract Introduction Sleep disturbance contributes to the burden of Alzheimer’s disease (AD), specifically among vulnerable patients with behavioral symptoms and multiple comorbidities. Limited information exists regarding the characteristics associated with insomnia among patients with AD. This study describes medical conditions and healthcare utilization among patients with AD and insomnia. Methods This retrospective cohort study used MarketScan® Multi-State Medicaid Database 2016-2020 and included adults aged ≥ 50 with newly diagnosed AD. Index date was the earliest medical or pharmacy claim date for insomnia within 3 months prior to 12 months post AD date. For comparison, non-insomnia cohort was selected based on propensity score 1:1 matching. Comorbid conditions and behavioral symptoms (BS) - including agitation aggression, psychotic symptoms, and mood disorders – and delirium were measured in the 12-month baseline period and were compared across insomnia and non-insomnia cohorts using chi-square tests. Healthcare utilization was assessed in 12-month post-index date (follow-up period). Results Among patients with incident AD, significantly higher proportions of individuals with comorbidities were detected in insomnia (N=3,904) vs. non-insomnia (N=3,904) cohorts in 12-month baseline period, i.e., hypertension (76.2% vs. 71.2%, p < 0.001), diabetes (35% vs. 32.9%, p=0.05), valvular disease (11.6% vs. 9.8%, p=0.01), delirium (5.1% vs. 3.7%, p=0.002) and BS (62.4% vs. 46%, p< 0.0001). The proportion of patients with BS during follow-up was higher in the insomnia cohort (76.18%) in comparison to the non-insomnia cohort (53.53%). In the follow-up, proportion of inpatient, emergency room and physician office visits were 34.5%, 49.8%, 45.6% in insomnia and 30.7%, 42.5%, 41.2% in non-insomnia cohorts respectively. Mean (SD) inpatient length-of-stay was 3.2 (9.62) days for insomnia and 2.6 (8.52) days for non-insomnia cohorts respectively. Conclusion The study results indicate that major comorbidities and behavioral symptoms are highly prevalent among insomnia patients with AD. Insomnia is associated with higher utilization rates when healthcare use is compared between insomnia and non-insomnia patients. Optimization of insomnia treatment is crucial for the disease management in AD patients. Support (if any) Funding for this research was provided by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Rahway, NJ, USA.