Treatment Patterns for Sleep Disorders in the United States Veterans Affairs Healthcare System
Author(s)
Karla Brandao-Viruet, MD1, Ying Wang, PhD2, Joel Reisman, BS3, Shibei Zhao, MS4, Brant Mittler, MD, JD5, Dan Berlowitz, MD3, Peter J Morin, MD, PhD6, Amir Abbas Tahami Monfared, MD, PhD7, Margaret Moline, PhD7, Quan Zhang, PhD7, Weiming Xia, PhD6.
1Tufts Medical Center, Boston, MA, USA, 2Wentworth Institute of Technology, Boston, MA, USA, 3University of Massachusetts, Lowell, MA, USA, 4University of Massachusetts Lowell, Lowell, MA, USA, 5South Texas VA Healthcare System, San Antonio, TX, USA, 6Boston University, Boston, MA, USA, 7Eisai, Inc, Nutley, NJ, USA.
1Tufts Medical Center, Boston, MA, USA, 2Wentworth Institute of Technology, Boston, MA, USA, 3University of Massachusetts, Lowell, MA, USA, 4University of Massachusetts Lowell, Lowell, MA, USA, 5South Texas VA Healthcare System, San Antonio, TX, USA, 6Boston University, Boston, MA, USA, 7Eisai, Inc, Nutley, NJ, USA.
OBJECTIVES: This study evaluated treatment patterns for select sleep medications in the Veterans Affairs Health System (VAHS) and the Centers for Medicare and Medicaid Services (CMS).
METHODS: We identified all patients aged ≥50 years with select sleep medication prescriptions in the merged VAHS and CMS databases (2020-2022). Clinical Practice Guidelines for pharmacological treatment of insomnia define nonbenzodiazepines such as Z-drugs as first-line. Other treatments may include the melatonin receptor agonist (ramelteon) or sedating antidepressants (trazodone, off label). The FDA has also approved three dual orexin receptor antagonists (DORAs), suvorexant, lemborexant, and daridorexant. Frequency distributions of the select sleep drugs were examined.
RESULTS: Among Veterans using VA outpatient services (N=6,761,233), we identified 906,519 patients with ≥1 sleep drug prescribed during the 2020-2022 study period. Patients had a mean (SD) age of 65.2 (13.1) years at first prescription; 9.4% were women, 17.8% were Black/African American vs 71.1% White, and 6.7% were Hispanic vs 87.5% non-Hispanic. Overall, an estimated 2.6% were prescribed zolpidem, 0.7% temazepam, 0.28% eszopiclone, 0.12% ramelteon, 0.06% zaleplon, 0.05% suvorexant, 0.04% triazolam, 0.006% lemborexant, 0.005% estazolam, and 0.001% daridorexant. Use of sedative antidepressants was prevalent (trazodone 10.4%; doxepin 0.9%). Over the 3-year period, most patients (89%) used a single sleep medication and 9.6% used 2 drugs. Melatonin supplements were prescribed in 46.2% of patients in conjunction with the other sleep medications.
CONCLUSIONS: The Z-drug zolpidem was the most commonly prescribed medication indicated for insomnia. Sedative antidepressants were also frequently utilized, likely due to their affordability and the lack of widely accepted, cost-effective alternatives for managing insomnia. Lemborexant and daridorexant, more recently approved for insomnia, were prescribed less frequently and have not yet become mainstream frontline treatments. Further research is needed to understand the adoption, real-world usage patterns of DORAs, and the factors influencing their utilization.
METHODS: We identified all patients aged ≥50 years with select sleep medication prescriptions in the merged VAHS and CMS databases (2020-2022). Clinical Practice Guidelines for pharmacological treatment of insomnia define nonbenzodiazepines such as Z-drugs as first-line. Other treatments may include the melatonin receptor agonist (ramelteon) or sedating antidepressants (trazodone, off label). The FDA has also approved three dual orexin receptor antagonists (DORAs), suvorexant, lemborexant, and daridorexant. Frequency distributions of the select sleep drugs were examined.
RESULTS: Among Veterans using VA outpatient services (N=6,761,233), we identified 906,519 patients with ≥1 sleep drug prescribed during the 2020-2022 study period. Patients had a mean (SD) age of 65.2 (13.1) years at first prescription; 9.4% were women, 17.8% were Black/African American vs 71.1% White, and 6.7% were Hispanic vs 87.5% non-Hispanic. Overall, an estimated 2.6% were prescribed zolpidem, 0.7% temazepam, 0.28% eszopiclone, 0.12% ramelteon, 0.06% zaleplon, 0.05% suvorexant, 0.04% triazolam, 0.006% lemborexant, 0.005% estazolam, and 0.001% daridorexant. Use of sedative antidepressants was prevalent (trazodone 10.4%; doxepin 0.9%). Over the 3-year period, most patients (89%) used a single sleep medication and 9.6% used 2 drugs. Melatonin supplements were prescribed in 46.2% of patients in conjunction with the other sleep medications.
CONCLUSIONS: The Z-drug zolpidem was the most commonly prescribed medication indicated for insomnia. Sedative antidepressants were also frequently utilized, likely due to their affordability and the lack of widely accepted, cost-effective alternatives for managing insomnia. Lemborexant and daridorexant, more recently approved for insomnia, were prescribed less frequently and have not yet become mainstream frontline treatments. Further research is needed to understand the adoption, real-world usage patterns of DORAs, and the factors influencing their utilization.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
RWD52
Topic
Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Mental Health (including addition)