Incremental Economic Burden Associated with Insomnia Among Patients with Type 2 Diabetes in the United States: A Retrospective Claims Database Analysis

Abstract: Background: While insomnia occurs in half of adults with type 2 diabetes (T2D), its incremental economic impact in this population is unclear. Objectives: This study evaluated on healthcare resource utilization (HCRU) and costs in patients with T2D and comorbid insomnia. Methods: This retrospective study used the IBM MarketScan commercial claims databases (Jan 2014-Dec 2019) to identify patients age ≥18 years with; (1) ≥1 ICD-9/ICD-10 codes for insomnia OR ≥2 fills for the same commonly prescribed insomnia medication (zolpidem OR trazodone ≤150mg OR benzodiazepines); (2) ≥12 months of continuous enrollment pre-/post-index date (earliest diagnosis/medication fill); and, (3) ≥2 ICD-9/ICD-10 codes for T2D. Patients with sleep disorders other than insomnia were excluded. Patients (“insomnia cohort”) were matched 1:1 on age, sex and Elixhauser Comorbidity Index (ECI) to patients with T2D but without insomnia (“control cohort”). Generalized linear models compared adjusted HCRU and costs per-patient-per-month (PPPM) over 12 months follow-up. Results: Each cohort included 23,168 patients (mean age 59.9 years, 59.3% female, 6.3 ECI). In adjusted analyses and relative to controls, patients with insomnia were more likely to have ≥1 inpatient admission, longer inpatient stays, ≥1 emergency department (ED) visit and higher mean outpatient visits (all p