Benzodiazepine Usage, Healthcare Resource Utilization, and Costs Among Older Adults Treated with Common Insomnia Medications: A Retrospective Cohort Study

Figures & data

Table 1 Patient Demographics and Other Baseline Characteristics, Matched Benzodiazepine–Trazodone Cohorts and Matched Benzodiazepine–Zolpidem IR Cohorts

Category	Matched Benzodiazepine - Trazodone Cohorts					Matched Benzodiazepine - Zolpidem IR Cohorts
	Benzodiazepines		Trazodone		p value	Benzodiazepines		Zolpidem IR		p value
	N	%	N	%		N	%	N	%
Total	9192	100.00%	9192	100.00%		9075	100.00%	9075	100.00%
Gender
Male	2864	31.16%	2864	31.16%	1.000	2880	31.74%	2880	31.74%	1.000
Female	6328	68.84%	6328	68.84%		6195	68.26%	6195	68.26%
Age at Index Date
Mean (SD)	76.76	7.84	76.76	7.84	1.000	76.39	7.49	76.39	7.49	1.000
ECI Score (weighted)
Mean (SD)	4.79	7.36	5.03	7.73	0.026	4.69	7.35	4.79	7.40	0.380
Geographic Region
Northeast	2234	24.30%	2057	22.38%	0.000	2156	23.76%	2646	29.16%	0.000
North Central	2169	23.60%	2549	27.73%		2125	23.42%	2139	23.57%
South	3614	39.32%	3412	37.12%		3615	39.83%	3109	34.26%
West	1158	12.60%	1159	12.61%		1163	12.82%	1165	12.84%
Unknown	17	0.18%	15	0.16%		16	0.18%	16	0.18%
Health plan type
Comprehensive	3119	33.93%	4267	46.42%	0.000	3141	34.61%	3701	40.78%	0.000
HMO	1202	13.08%	816	8.88%		1183	13.04%	701	7.72%
PPO	3981	43.31%	3414	37.14%		3911	43.10%	3828	42.18%
Other	890	9.68%	695	7.56%		840	9.25%	845	9.32%
Comorbidities*
Any Psychiatric disorder	2450	26.65%	2883	31.36%	0.000	2515	27.71%	1685	18.57%	0.000
Diabetes	1918	20.87%	2411	26.23%	0.000	1909	21.04%	2073	22.84%	0.003
Hypertension	6519	70.92%	6546	71.21%	0.661	6382	70.33%	6113	67.36%	0.000
COPD	945	10.28%	963	10.48%	0.663	889	9.80%	855	9.42%	0.392
Osteoporosis	1593	17.33%	1320	14.36%	0.000	1551	17.09%	1418	15.63%	0.008
Alzheimer’s disease	1014	11.03%	1375	14.96%	0.000	1080	11.90%	480	5.29%	0.000
Medication use
Antidepressants	3449	37.52%	3933	42.79%	0.000	3500	38.57%	2758	30.39%	0.000
Oral hypoglycemics	1181	12.85%	1640	17.84%	0.000	1173	12.93%	1433	15.79%	0.000
Antihypertensives	6604	71.85%	7050	76.70%	0.000	6474	71.34%	6635	73.11%	0.008
Duration of exposure
0–3 months	6039	65.70%	5110	55.59%	0.000	5933	65.38%	6496	71.58%	0.000
>3–6 months	1392	15.14%	1189	12.94%		1390	15.32%	1366	15.05%
>6–9 months	774	8.42%	815	8.87%		775	8.54%	544	5.99%
>9–12 months	987	10.74%	2078	22.61%		977	10.77%	669	7.37%

Notes: *Includes only comorbidities with at least 10% prevalence in one or more medication cohorts.

Abbreviations: ECI, Elixhauser Comorbidity Index; SD, standard deviation; COPD, chronic obstructive pulmonary disease; HMO, health maintenance organization; PPO, preferred provider organization.

Figure 1 Differences in healthcare resource use between medication groups by point of service *p<0.05.

Table 2 Adjusted^a PPPM Costs by Index Medication for 12-Month Follow-Up

Category	Trazodone vs Benzodiazepines^b			Category	Zolpidem IR vs Benzodiazepines^c
	N (%)	Estimated Mean	Cost Ratio with 95% CI		N (%)	Estimated Mean	Cost Ratio with 95% CI
Total Costs				Total Costs
Trazodone	9192 (100%)	1767	0.88 (0.85,0.91)	Zolpidem IR	9075 (100%)	1984	0.96 (0.92,0.99)
Benzodiazepines	9192 (100%)	2007	Ref	Benzodiazepines	9075 (100%)	2073	Ref
Medical Costs				Medical Cost
Inpatient				Inpatient
Trazodone	1714 (18.65%)	2031	0.94 (0.88,1.01)	Zolpidem IR	1475 (16.25%)	2399	1.04 (0.98,1.11)
Benzodiazepines	1674 (18.21%)	2152	Ref	Benzodiazepines	1651 (18.19%)	2302	Ref
ED				ED Costs
Trazodone	2851 (31.02%)	267	0.94 (0.88,1)	Zolpidem IR	2469 (27.21%)	221	0.91 (0.85,0.98)
Benzodiazepines	2899 (31.54%)	284	Ref	Benzodiazepines	2893 (31.88%)	243	Ref
Outpatient				Outpatient
Trazodone	8965 (97.53%)	726	0.84 (0.81,0.87)	Zolpidem IR	8868 (97.72%)	831	0.93 (0.89,0.96)
Benzodiazepines	9139 (99.42%)	861	Ref	Benzodiazepines	9021 (99.4%)	895	Ref
Pharmacy Costs				Pharmacy Costs
All Pharmacy				All Pharmacy
Trazodone	9192 (100%)	436	0.97 (0.93,1)	Zolpidem IR	9075 (100%)	396	1.05 (1.02,1.1)
Benzodiazepines	9192 (100%)	451	Ref	Benzodiazepines	9075 (100%)	376	Ref
Index Drug				Index Drug
Trazodone	9192 (100%)	2	0.38 (0.37,0.4)	Zolpidem IR	9075 (100%)	3	0.55 (0.53,0.57)
Benzodiazepines	9192 (100%)	5	Ref	Benzodiazepines	9075 (100%)	5	Ref

Notes: ^aAll models adjusted for age, sex, geographical region, plan type, Elixhauser Comorbidity Index score, depression, diabetes, hypertension, osteoporosis, Alzheimer’s disease, antidepressant drug use, oral hypoglycemic drug use, and antihypertensive drug use at baseline, as well as index insomnia medication group exposure levels. ^bBenzodiazepines matched to trazodone. ^cBenzodiazepines matched to zolpidem IR.

Abbreviations: PPPM, per patient per month; USD, US dollars; CI, confidence interval; ED, emergency department; Ref, reference.

Figure 2 Differences in healthcare resource use between medication groups by categories of cost *p<0.05.