Untreated insomnia increases all-cause health care utilization and costs among Medicare beneficiaries. Issue 4 (12th January 2019)

• Record Type: Journal Article
• Authors: Wickwire, Emerson M; Tom, Sarah E; Scharf, Steven M; Vadlamani, Aparna; Bulatao, Ilynn G; Albrecht, Jennifer S
• Is Part Of: Sleep. Volume 42:Issue 4(2019)
• Publication Date: 2019-01-12
• Subjects: sleep -- insomnia -- health care utilization -- health economics -- costs -- Medicare -- older adults; Sleep -- Physiological aspects -- Periodicals; Sleep disorders -- Periodicals; Sommeil -- Aspect physiologique -- Périodiques; Sommeil, Troubles du -- Périodiques; Sleep disorders; Sleep -- Physiological aspects; Sleep -- physiological aspects; Sleep Wake Disorders; Psychophysiology; Electronic journals; Periodicals; 616.8498
• DOI: 10.1093/sleep/zsz007
• Languages: English
• ISSNs: 0161-8105

Abstract

Abstract: Study Objectives: To examine the impact of untreated insomnia on health care utilization (HCU) among a nationally representative sample of Medicare beneficiaries. Methods: Our data source was a random 5% sample of Medicare administrative data for years 2006–2013. Insomnia was operationalized as the presence of at least one claim containing an insomnia-related diagnosis in any given year based on International Classification of Disease, Version 9, Clinical Modification codes or at least one prescription fill for an insomnia-related medication in Part D prescription drug files in each year. We compared HCU in the year prior to insomnia diagnosis to HCU among to non-sleep disordered controls during the same period. Results: A total of 151 668 beneficiaries were found to have insomnia. Compared to controls ( n = 333 038), beneficiaries with insomnia had higher rates of HCU across all point of service locations. Rates of HCU were highest for inpatient care (rate ratio [RR] 1.61; 95% confidence interval [CI] 1.59, 1.64) and lowest for prescription fills (RR 1.17; 95% CI 1.16, 1.17). Similarly, compared to controls, beneficiaries with insomnia demonstrated $63, 607 (95% CI $60, 532, $66, 685) higher all-cause costs, which were driven primarily by inpatient care ($60, 900; 95% CI $56, 609, $65, 191). Emergency department ($1, 492; 95% CI $1, 387, $1, 596) and prescription costs ($486; 95% CI $454, $518) were also elevated among cases relative to controls. Conclusions: In this randomly selected and nationally representative sample of older Medicare beneficiaries and compared to non-sleep disordered controls, individuals with untreated insomnia demonstrated increased HCU and costs across all points of service.