PHP32 - Discontinuation of Benzodiazepine(Bzd) and Non-Benzodiazepine(Z-Drug) Hypnotics Among Elderly in Taiwan: Associated Factors and Outcomes for Patients with Different Discontinue Timing

Abstract

Inappropriate use of BZD/Z-drug hypnotics may result in falling and occurrence of fracture events. There is no consensus of discontinue timing for those elderly BZD/Z-drug hypnotic users yet. This study aims to investigate the associated factors of discontinuation, the timing to discontinue BZD/Z-drugs and its outcomes. We utilized 2000 and 2005 Longitudinal National Health Insurance Databases, from which two million beneficiaries were randomly selected from all of the registered beneficiaries in Taiwan. Those patients who were newly prescribed with BZD/Z-drug hypnotics in 2009 were evaluated for their potential associated factors (demographic, comorbidity, health utility, initial prescription pattern) about their tendency of discontinuation through cox-regression analyses. Further, we explored the discontinuation-related outcomes (e.g., fracture, reuse) for up to 360 days after discontinuation of BZD/Z-drugs between different timing (within or more than 30-/90-days) through performing survival analysis approaches. Of 15,684 elder patients who newly used BZD/Z-drugs in 2009 were followed-up to up 360-day, 50% of them discontinued after 98 days. Those elderly with some diseases (e.g., cardiovascular-related, diabetes, mental disorder) tended to not discontinue, whereas who ever combined BZD/Z-drugs with pain killers tended to discontinue. Those elderly who discontinued BZD/Z-drugs within 90-days tended to reuse earlier than those who discontinued within 30-days during 360-day follow-up period, whereas the time-to-fracture events were not different. Half elderly discontinued their initial use of BZD/Z-drugs in more than 90 days in Taiwan. Those elderly with certain diseases tended to discontinue these medications, whereas the reuse patterns were different among 30-day or 90-day discontinuation patients but not for the fracture. Regardless, more attention is needed on elderly patients’ use patterns of BZD/Z-drugs, its associated factors and consequences in order to ensure safe use of BZD/Z-drugs in Taiwan.