Comorbid Insomnia Exacerbates Health Care Utilization, Cost Burden in Patients With Alzheimer Disease

Comorbid insomnia in patients with Alzheimer disease (AD) may significantly increase utilization of higher-cost health care services and total annual health care costs, according to study findings published in the Journal of Alzheimer's Disease.

With the estimated 5.8 million Americans 65 years and older living with AD projected to more than double by 2050, the increased need for care associated with these populations was noted by researchers to create a significant financial burden.

In fact, costs associated with health care and long-term care for those with dementia due to AD and other causes were estimated to be $290 billion in 2019, with the average Medicare beneficiary with AD costing $35,000 more annually than Medicare beneficiaries without the condition.

Among the several comorbidities known to exacerbate symptoms of AD, sleep disorders have been theorized to share a bidirectional relationship with the neurocognitive condition, as poor sleep is both a cause and a consequence of AD. Moreover, sleep disorders such as insomnia are known to occur more frequently in patients with AD than in the general population.

“In patients with AD, sleep disturbances are associated with worsening behavioral and psychological symptoms, which may lead to increased caregiver burden, increased fall risk, and increased use of high cost interventions such as skilled nursing support and early institutionalization,” wrote the study authors.

With no prior research examining the health care resource utilization and cost implications of insomnia in AD, they conducted a retrospective cohort study to gauge the incremental health care burden of both comorbid conditions using real-world evidence.

The study recruited patients with AD selected from IBM MarketScan Commercial and Medicare Supplemental Databases, in which patients with claims-based evidence of insomnia (n = 3500) were compared with a matched cohort of patients without insomnia (n = 9884) over a 12-month follow-up period.

In the study, patients with comorbid AD and insomnia were found to report a higher comorbidity burden at baseline, as measured by the Charlson Comorbidity Index (mean score, 2.5 vs 2.2; P < .001). Moreover, patients with AD and insomnia were significantly more likely than the cohort without insomnia to report baseline diagnoses of other conditions such as depression, moderate or severe liver disease, and myocardial infarction (all, P < .001).

In assessing the health care burden of both groups, patients with both comorbid conditions were found to be more likely to have a claim for higher-cost health care services than those without insomnia, including inpatient hospitalization (39.8% vs 32.3%), emergency department care (56.4% vs 48.0%), and skilled nursing care (42.6% vs 31.9%) (all, P < .05).

Over the 12-month follow-up period, mean total annual health care costs were significantly higher among patients with AD and insomnia compared with those without insomnia ($37,356 vs $27,990; P < .001).

“This real-world analysis provides evidence that AD disease management should consider proper treatment of comorbid insomnia due to the incremental burden and cost implications,” concluded the study authors.

Reference

Qureshi ZP, Thiel E, Nelson J, Khandker R. Incremental healthcare utilization and cost burden of comorbid insomnia in Alzheimer’s disease patients. J Alzheimers Dis. Published online August 20, 2021. doi:10.3233/JAD-210713