Lifetime burden of prescription medication for insomnia in middle-aged and older adults in the US: a microsimulation study.

Background: Prescription sleep medications, including z-drugs, benzodiazepines, and trazodone, are commonly used treatments in older adults for insomnia, but have negative consequences related to injuries, cognitive impairment, and quality of life. This study estimates the remaining lifetime burden of sleep medication for US individuals over 50 years of age. Methods: This study utilized the Future Elderly Model, a state-transition microsimulation based on 1998-2018 data from the Health and Retirement Study, to evaluate health and economic outcomes among individuals over 50 who regularly use prescription medications to help sleep. We simulated the status quo scenario and compared it to a scenario without future sleep medication use. Findings: Avoiding future sleep medication use in 15.3 million Americans over age 50 regularly using these drugs decreased lifetime incidence of falls by 8.5% (95% CI, 7.3-9.7) cognitive impairment by 2.1% (95% CI, 1.7-2.6), and increased life expectancy with 0.11 years (95% CI, 0.09-0.14). Collectively, eliminating future use could save 1.7 million life years and 1.3 million quality-adjusted life years in this cohort. The net lifetime economic savings was $6.6 K (95% CI: 4.7-8.5, 2024$) per person and $101 billion (95% CI: 72-129) in the US. The largest share is attributed to improved quality of life. Interpretation: In this microsimulation study, sleep medications in the status quo scenario worsen quantity and quality of life. Deprescribing efforts may improve quality of life for middle-aged and older Americans. Funding: National Heart, Lung & Blood Institute.