Clinical insomnia, estimated to affect 30 million people in the United States, is characterized by daytime dysfunction as a consequence of one or more of the following sleep problems: difficulty initiating and/or maintaining restorative sleep, early morning awakening, and intermittent wakefulness throughout the night. Primary treatment goals are to improve sleep quality and quantity and to improve insomnia-related daytime impairments, with minimal next-day side effects. While current therapies—largely composed of generic options, including benzodiazepines, non-benzodiazepine sedative-hypnotics, and antidepressants—are effective in their ability to improve sleep quality, they leave room for improvement on next-day functioning and residual psychomotor effects.

Using national patient-level claims data, the Treatment Algorithms in Insomnia report explores the use of key therapies and drug classes among newly diagnosed and recently treated insomnia patient populations. For the newly diagnosed patients, the report provides a quantitative analysis of percentage drug-treated and time to treatment, treatment patterns and share by line of therapy, as well as progression between lines, recent patient share trends, and use of concomitant treatment. For recently treated patients, the report quantifies a drug’s overall drug share, use in combination with other therapies, and source of business compared with its competitors, detailing which drugs precede others through an analysis of add-versus-switch patterns. Two additional claims database queries explore persistency and compliance by therapy.

Questions Answered in This Report:

  • Newly diagnosed patients: Nearly half of newly diagnosed insomnia patients initiate treatment with a prescription insomnia therapy within one year of diagnosis. What percentage of these patients progress to a second- or third-line drug within the first year, and how quickly do patients progress? Which products capture the most patient share in the first, second, and third lines of treatment? How often is combination therapy used in each line of therapy?

  • Recently treated patients: In Q3 2014, insomnia treatment was largely divided between sedative-hypnotics and antidepressants. Which specific drugs garner the most patient share for recently treated insomnia patients? How have the more recently launched branded formulations of zolpidem been incorporated into treatment? Which therapies have experienced market growth or decline over the key therapy periods studied?

  • Pathways to key therapies: Among patient share leaders for insomnia, zolpidem IR is the most likely treatment to precede most agents, consistent with this drug’s leading position in early lines of therapy. How long does it take an insomnia patient to progress to each key therapy? What are the various sources of business for each agent (i.e., new, add/switches, or continuing business)?

Scope:

Primary patient-level data: This report provides quantitative findings from our analysis of data covering approximately 40 million lives and provides the most representative sample of U.S. treatment practice for Medicare and commercially insured patients. The report is delivered as a key findings slide deck and a dashboard that can be accessed using the Internet and presents claims that are 6-12 months old at the time of publication.

Patient Sample: Patients who are continuously enrolled for the complete two-year study period must meet the following condition: at least one claim with a diagnosis code for insomnia (International Classification of Diseases, Ninth Revision [ICD-9] diagnostic codes 307.40, 307.41, 307.42, 307.49, 327.00, 327.01, 327.02, 327.09, 327.80, 780.50, 780.52, 780.59) during the study period. All patients must be aged 15 years or older to qualify.

Newly diagnosed patients:

- Patient share by drug class and key products across three lines of therapy, within one year of diagnosis.

- Patient flowcharts through one year of treatment for all first-line products, including progression rates and add/switch behavior.

- Polypharmacy and key concomitant therapies by line of therapy.

- Quarterly trending of patient share by line of therapy.

Recently treated patients:

- Quarterly snapshot of patient share by drug class and key products.

- Pathway to key therapy flowcharts tracking the preceding therapy patterns for all key therapies including add/switch behavior.

- Brand source of business including share for continuing, new (switches/adds), and new (initial therapy) business.

- Polypharmacy and key concomitant therapies.

- Quarterly trends in patient share for all key therapies.

Drug persistence (One year, all-brand).

Drug compliance (6-month, Medication Possession Ratio [MPR]).

Author(s): Tamara Blutstein

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