0411 Trends in Insomnia Prescription MedicTrends in Insomnia Prescription Medication Use Among Medicare Beneficiaries, 2006–2013

Abstract

Traditional pharmacotherapy for insomnia has known adverse outcomes among older adults, including falls and cognitive impairment. However, few studies have characterized longitudinal insomnia-related medication trends among Medicare beneficiaries. These characteristics are of particular interest given the recent (2012) inclusion of benzodiazepines in the Medicare prescription drug formulary. The objective of this study was to characterize trends in insomnia-related prescription medication use among Medicare beneficiaries over a seven-year period. We conducted a time-series analysis to estimate the annual prevalence of use of insomnia medications using a 5% sample of Medicare fee-for-service beneficiaries from 2006–2013. Insomnia medication use (defined as at least 1 fill annually) was identified by searching the Part D prescription drug claims and included insomnia-related medication classes and drugs: barbiturates, benzodiazepines, chloral hydrate, hydroxyzine, non-benzodiazepine sedative hypnotics (NBSH), and sedating anti-depressants. Prevalence of insomnia medication use ranged from 20.8% in 2006 to 23.4% in 2013 (p>.10). Benzodiazepine use increased from 0.5% in 2012 to 8.0% in 2013 (p = 0.03). Use of sedating antidepressants and NBSH decreased modestly from 9% and 8%, respectively, in 2006 through 2013. Prevalence of sedating antidepressant, NBSH, and hydroxyzine use was higher among women than men (p<0.001 for all). Benzodiazepine and sedating antidepressant use was most common among those age <65 and ≥85 years. NBSH use was most common among those age <65 years. Use of all drugs was similar among those ages 65 - 74 years and 75 - 84 years. Prevalence of insomnia medication use remained high among Medicare beneficiaries from 2006 - 2013, particularly among women. Benzodiazepine use increased sharply following inclusion in the Medicare formulary. Future studies should examine population-level outcomes associated with this increased use of benzodiazepines. Merck Investigator Initiated Studies Program (PI: Wickwire).