Trends in Dispensing of Zolpidem and Low-Dose Trazodone Among Commercially Insured Adults in the United States, 2011-2018

Abstract

This study uses IBM MarketScan database data to describe trends in zolpidem and low-dose trazodone dispensing among adults with employer-sponsored insurance or Medicare supplemental plans between 2011 and 2018, before and after a 2017 clinical practice guideline discouraged trazodone use for insomnia.

Figure 1.. Percentage of Commercially Insured Adults Dispensed Zolpidem or Low-Dose Trazodone, 2011-2018

The 2011 to 2018 IBM MarketScan Research Databases were used to measure trends in the dispensing of zolpidem and low-dose trazodone among US adults (aged ≥18 years) with employer-sponsored insurance or Medicare supplemental plans. For each year, the percentage of adults who received at least 1 dispensing of low-dose trazodone (<150 mg/d or ≤50 mg/d) or any dosage of zolpidem was calculated among all adults who contacted the health care system in the year and had at least 12 months of prior continuous medical and drug insurance (mean of 16.6 million adults per year in the MarketScan databases). Individuals who had trazodone dispensed multiple times in a given year were counted only if all prescriptions dispensed were below the dose threshold to avoid counting individuals tapering up to or down from higher dosages (more likely indicated for depression). Multivariable binomial regression models were used to estimate the annual percentage change in the dispensing of each drug in 2011 to 2018, adjusted for age, sex, and depression diagnosis, in which depression diagnosis was defined as having at least 2 outpatient codes or 1 inpatient code for depression in the past year. The short black dashes above the vertical bars indicate the 95% CIs around the annual percentages.

Figure 2.. Percentage of Commercially Insured Adults With an Insomnia Diagnosis Dispensed Zolpidem or Low-Dose Trazodone, 2011-2018

The 2011 to 2018 IBM MarketScan Research Databases were used to measure trends in the dispensing of zolpidem and low-dose trazodone among US adults (aged ≥18 years) with employer-sponsored insurance or Medicare supplemental plans who had a diagnosis code for insomnia. For each year, the percentage of adults who received at least 1 dispensing of low-dose trazodone (<150 mg/d or ≤50 mg/d) or any dosage of zolpidem was calculated among all adults who contacted the health care system in the year, had at least 12 months of prior continuous medical and drug insurance, and had a diagnosis code for insomnia recorded in the past year (mean of 781 790 adults per year in the MarketScan databases). Individuals who had trazodone dispensed multiple times in a given year were counted only if all prescriptions dispensed were below the dose threshold to avoid counting individuals tapering up to or down from higher dosages (more likely indicated for depression). Multivariable binomial regression models were used to estimate the annual percentage change in the dispensing of each drug in 2011 to 2018, adjusted for age, sex, and depression diagnosis, in which depression diagnosis was defined as having at least 2 outpatient codes or 1 inpatient code for depression in the past year. The short black dashes above the vertical bars indicate the 95% CIs around the annual percentages.