Association of Initial Z-drug Prescription Duration and Long-Term Use...
Author(s)
Jonathan N. Cloughesy, BS1, Johanna Thunell, PhD2, Stephen D. Persell, MD, MPH, FACP3, Jeffrey A. Linder, MD, MPH, FACP3, Mark D. Sullivan, MD, PhD4, Xiaofan Liu, MPH1, Jason N. Doctor, PhD5.
1Department of Pharmaceutical and Health Economics, University of Southern California, Los Angeles, CA, USA, 2Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA, 3Northwestern University Feinberg School of Medicine, Chicago, IL, USA, 4University of Washington School of Medicine, Seattle, WA, USA, 5University of Southern California, Los Angeles, CA, USA.
1Department of Pharmaceutical and Health Economics, University of Southern California, Los Angeles, CA, USA, 2Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA, 3Northwestern University Feinberg School of Medicine, Chicago, IL, USA, 4University of Washington School of Medicine, Seattle, WA, USA, 5University of Southern California, Los Angeles, CA, USA.
OBJECTIVES: Z-drugs, including zolpidem, zaleplon, and eszopiclone, are medications prescribed to help patients initiate and maintain sleep. Despite being marketed as alternatives to benzodiazepines, Z-drugs have similar risk profiles and can result in an elevated risk of dependence, falls and fractures, and motor vehicle accidents. For this reason, clinical guidelines indicate that Z-drugs should not be used for more than 4-5 weeks. However, Z-drugs are commonly prescribed in durations that exceed these guidelines. This study investigates the association between the duration and dosage of an initial Z-drug prescription among naive Z-drug users and subsequent, long-term Z-drug use.
METHODS: In this retrospective cohort study, we use claims data between 2007 and 2024 from a nationwide commercial insurer database in the United States. Patients above the age of 18 with a Z-drug prescription are included in the sample if they have at least 12 months of continuous enrollment with the insurer prior to their index prescription, and 24 months of continuous enrollment after the index prescription. Z-drug patients are followed through the remainder of their enrollment. We assess the impact of the index prescription's dose and duration on subsequent duration and intensity of Z-drug use.
RESULTS: The likelihood of long-term Z-drug use (defined as > 180 days supply within one year following index prescription) increased with each additional day of supply provided by the initial prescription to naive Z-drug users. Initial prescription length was associated with continued Z-drug use over 10 years later. Dosage of the initial prescription also resulted in statistically significant increases in long-term Z-drug use.
CONCLUSIONS: Our research identifies a strong association between initial prescription duration and dosage on the subsequent long-term use of Z-drugs among naive Z-drug patients. Clinician-facing behavioral interventions to align Z-drug prescribing with clinical guidelines may help reduce risks associated with overprescribing.
METHODS: In this retrospective cohort study, we use claims data between 2007 and 2024 from a nationwide commercial insurer database in the United States. Patients above the age of 18 with a Z-drug prescription are included in the sample if they have at least 12 months of continuous enrollment with the insurer prior to their index prescription, and 24 months of continuous enrollment after the index prescription. Z-drug patients are followed through the remainder of their enrollment. We assess the impact of the index prescription's dose and duration on subsequent duration and intensity of Z-drug use.
RESULTS: The likelihood of long-term Z-drug use (defined as > 180 days supply within one year following index prescription) increased with each additional day of supply provided by the initial prescription to naive Z-drug users. Initial prescription length was associated with continued Z-drug use over 10 years later. Dosage of the initial prescription also resulted in statistically significant increases in long-term Z-drug use.
CONCLUSIONS: Our research identifies a strong association between initial prescription duration and dosage on the subsequent long-term use of Z-drugs among naive Z-drug patients. Clinician-facing behavioral interventions to align Z-drug prescribing with clinical guidelines may help reduce risks associated with overprescribing.
Conference/Value in Health Info
2025-09, ISPOR Real-World Evidence Summit 2025, Tokyo, Japan
Value in Health Regional, Volume 49S (September 2025)
Code
RWD251
Topic Subcategory
Health & Insurance Records Systems
Disease
SDC: Neurological Disorders