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Sedative-hypnotic medicines and falls in community-dwelling older adults: a cost-effectiveness (decision-tree) analysis from a US Medicare perspective.
Drugs Aging. 2015 Apr; 32(4):305-14.DA

Abstract

BACKGROUND

Both the 2012 Beers list and the American Geriatric Society 'Choosing Wisely' campaign suggest restraint in the use of sedative-hypnotics for the treatment of insomnia in older people. Sedative hypnotic agents continue to be widely prescribed even though their use in the elderly is associated with an increased risk of falls, fractures, and emergency hospitalizations.

OBJECTIVE

The aim of this study was to estimate the cost effectiveness of cognitive behavioral therapy (CBT) compared with sedative-hypnotics and no treatment for insomnia in the US Medicare population, adjusting for the risk of falls and related consequences.

METHODS

A model-based economic evaluation (decision tree) using the US Medicare perspective and a conservative annual temporal framework was conducted. Simulations were performed in a hypothetical cohort of Medicare beneficiaries suffering from insomnia. The main outcome measure was the incremental cost per quality-adjusted life year (QALY) gained. Sensitivity analyses assessed the robustness of the base-case analysis.

RESULTS

On an annual basis, CBT showed a dominance (cost: US$19,442; QALYs: 0.594) over sedative hypnotics (cost: US$32,452; QALYs: 0.552) and no treatment (cost: US$33,853; QALYs: 0.517). Assuming a willingness to pay of US$50,000, the net monetary benefit was positive for CBT (US$10,287) and negative for sedative hypnotics (-US$4,851) and no treatment (-US$7,993). CBT had a 95% chance of being the dominant strategy, with results most sensitive to an older adult's baseline risk of falling.

CONCLUSION

Failure to consider drug harms such as drug-induced falls and hospitalization represents a growing public health concern, significantly underestimating the cost of sedative-hypnotic therapy and loss in quality of life for the elderly. Public payers should reconsider reimbursement of sedative-hypnotic drugs as first-line treatment for insomnia in older adults.

Authors+Show Affiliations

Faculties of Medicine and Pharmacy, Université de Montréal, Montreal, QC, Canada, cara.tannenbaum@umontreal.ca.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25825121

Citation

Tannenbaum, Cara, et al. "Sedative-hypnotic Medicines and Falls in Community-dwelling Older Adults: a Cost-effectiveness (decision-tree) Analysis From a US Medicare Perspective." Drugs & Aging, vol. 32, no. 4, 2015, pp. 305-14.
Tannenbaum C, Diaby V, Singh D, et al. Sedative-hypnotic medicines and falls in community-dwelling older adults: a cost-effectiveness (decision-tree) analysis from a US Medicare perspective. Drugs Aging. 2015;32(4):305-14.
Tannenbaum, C., Diaby, V., Singh, D., Perreault, S., Luc, M., & Vasiliadis, H. M. (2015). Sedative-hypnotic medicines and falls in community-dwelling older adults: a cost-effectiveness (decision-tree) analysis from a US Medicare perspective. Drugs & Aging, 32(4), 305-14. https://doi.org/10.1007/s40266-015-0251-3
Tannenbaum C, et al. Sedative-hypnotic Medicines and Falls in Community-dwelling Older Adults: a Cost-effectiveness (decision-tree) Analysis From a US Medicare Perspective. Drugs Aging. 2015;32(4):305-14. PubMed PMID: 25825121.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sedative-hypnotic medicines and falls in community-dwelling older adults: a cost-effectiveness (decision-tree) analysis from a US Medicare perspective. AU - Tannenbaum,Cara, AU - Diaby,Vakaramoko, AU - Singh,Dharmender, AU - Perreault,Sylvie, AU - Luc,Mireille, AU - Vasiliadis,Helen-Maria, PY - 2015/4/1/entrez PY - 2015/4/1/pubmed PY - 2016/3/12/medline SP - 305 EP - 14 JF - Drugs & aging JO - Drugs Aging VL - 32 IS - 4 N2 - BACKGROUND: Both the 2012 Beers list and the American Geriatric Society 'Choosing Wisely' campaign suggest restraint in the use of sedative-hypnotics for the treatment of insomnia in older people. Sedative hypnotic agents continue to be widely prescribed even though their use in the elderly is associated with an increased risk of falls, fractures, and emergency hospitalizations. OBJECTIVE: The aim of this study was to estimate the cost effectiveness of cognitive behavioral therapy (CBT) compared with sedative-hypnotics and no treatment for insomnia in the US Medicare population, adjusting for the risk of falls and related consequences. METHODS: A model-based economic evaluation (decision tree) using the US Medicare perspective and a conservative annual temporal framework was conducted. Simulations were performed in a hypothetical cohort of Medicare beneficiaries suffering from insomnia. The main outcome measure was the incremental cost per quality-adjusted life year (QALY) gained. Sensitivity analyses assessed the robustness of the base-case analysis. RESULTS: On an annual basis, CBT showed a dominance (cost: US$19,442; QALYs: 0.594) over sedative hypnotics (cost: US$32,452; QALYs: 0.552) and no treatment (cost: US$33,853; QALYs: 0.517). Assuming a willingness to pay of US$50,000, the net monetary benefit was positive for CBT (US$10,287) and negative for sedative hypnotics (-US$4,851) and no treatment (-US$7,993). CBT had a 95% chance of being the dominant strategy, with results most sensitive to an older adult's baseline risk of falling. CONCLUSION: Failure to consider drug harms such as drug-induced falls and hospitalization represents a growing public health concern, significantly underestimating the cost of sedative-hypnotic therapy and loss in quality of life for the elderly. Public payers should reconsider reimbursement of sedative-hypnotic drugs as first-line treatment for insomnia in older adults. SN - 1179-1969 UR - https://www.unboundmedicine.com/medline/citation/25825121/Sedative_hypnotic_medicines_and_falls_in_community_dwelling_older_adults:_a_cost_effectiveness__decision_tree__analysis_from_a_US_Medicare_perspective_ L2 - https://dx.doi.org/10.1007/s40266-015-0251-3 DB - PRIME DP - Unbound Medicine ER -