The Cost of Untreated Insomnia

Untreated Insomnia Has Exhausting Effect on Health Resources

Caroline Cassels

Medscape Medical News 2007. © 2007 Medscape

March 8, 2007 — The costs of untreated insomnia far outweigh the costs of not treating this common disorder, which affects 10% of the US population, a new study suggests.

Investigators from Cornell University found even the most expensive medications cost less than $200 per year for the typical insomnia patient vs $924 to $1143 more in medical expenses in the 6 months before treatment initiation.

"Our study suggests that it costs far less to treat insomnia than to ignore it. Untreated insomnia affects individuals' health, quality of life,and job performance — and increases their use of healthcare services substantially," said the study's lead author, Ronald Ozminkowski, PhD, from the Institute for Health and Productivity Studies, Cornell University, Washington, DC, in a statement from the American Academy of Sleep Medicine.

The study is published in the March issue of Sleep.

Using data from self-insured, employer-sponsored health insurance plans in the United States, investigators examined health and employment data from 214,378 patients with insomnia and looked at their health costs in the 6 months before diagnosis.

Unconventional Approach

According to the authors, the typical approach used to assess the burden of insomnia has been has been to focus on the current cost of treatment. However, they note, looking at costs of untreated insomnia may be more informative.

"Unlike many other medical conditions, insomnia is not an expensive condition to treat. . . . We therefore assumed that a more complete understanding of its burden of illness can be gained by estimating cost differences between similar insomnia and noninsomnia patients, shortly before diagnosis or treatment begins," they write.

Direct costs were investigated using information from medical claims for inpatient, outpatient, pharmacy, and emergency room expenses from July 1, 1999 to June 30, 2003. Expenditures for these services were all adjusted for inflation to reflect 2003 metrics.

Expenditures for 138,820 patients aged 18 to 64 years and 75,558 elderly insomnia patients older than 64 years were compared with 2 equal-sized, matched control groups who did not have insomnia.

To estimate indirect costs, absenteeism records and short-term disability program records were examined for matched workers who did and did not develop insomnia.

Insomnia Burden Underestimated?

The investigators found that combined direct and indirect medical expenses for younger patients were $1253 higher for those eventually diagnosed with insomnia compared with controls without insomnia. Similarly, combined costs for elderly patients diagnosed with insomnia were $1,143 higher that those of their counterparts without insomnia.

With approximately 25 million to 30 million Americans suffering from chronic insomnia, the authors point out that their findings have major implications for employers, health plans, government insurance programs, and individuals.

In addition, they note, the study did not take into account the impact of insomnia on psychosocial functioning, accident rates, or productivity at work and therefore the calculations in this study may be an underestimation of the insomnia burden in the United States.

Furthermore, it is known that many insomnia patients do not seek medical treatment and therefore it is likely that a proportion of the control groups had undiagnosed or untreated insomnia, which may also lead to a conservative estimate of cost burden.

Sleep. 2007;30:263-273.