Incremental Healthcare Costs of Insomnia Among Adult Patients With Alzheimer’s Disease or Related Dementias in the United States

Abstract: Background: Insomnia contributes to cognitive decline, increased fall risk, and nursing home placement in patients with Alzheimer’s disease and related dementias (ADRD). Objectives: This study evaluated all-cause health care resource utilization (HCRU) and costs in ADRD patients with insomnia. Methods: This retrospective study used the IBM MarketScan commercial claims databases (Jan 2014-Dec 2019) to identify patients: (1) age ≥45 years; (2) with ≥1 ICD-9/ICD-10 codes for insomnia OR with ≥2 fills for the same commonly prescribed insomnia medication (zolpidem OR trazodone ≤150mg OR benzodiazepines); (3) with ≥12 months of continuous enrollment pre-/post-index date (earliest diagnosis/medication fill); and (4) with ≥2 ICD-9/ICD-10 codes for ADRD. 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 ADRD patients without sleep disorders (“control cohort”). Generalized linear models compared adjusted outcomes between cohorts per-patient-per-month (PPPM) over 12 months follow-up. Results: Each cohort included 3,015 ADRD patients (mean age 84.8 years, 72.4% female, 17.3 ECI). In adjusted analyses and relative to controls, insomnia patients were more likely to have ≥1 inpatient admission (p