Healthcare utilization and costs in persons with insomnia in a managed care population

Am J Manag Care. 2014 May;20(5):e157-65.


Objectives: To better understand the direct costs of insomnia. Our study aimed to compare healthcare costs and utilization of patients diagnosed with insomnia who received care in a managed care organization with a set of matched controls.

Design: Our observational, retrospective cohort study compared 7647 adults with an insomnia diagnosis with an equally sized matched cohort of health plan members without an insomnia diagnosis between 2003 and 2006. We also compared a subset of patients diagnosed with and treated for insomnia with those diagnosed with insomnia but not treated.

Setting: A large Midwestern health plan with more than 600,000 members.

Results: Multivariate analysis was used to estimate the association between insomnia diagnosis and costs, controlling for covariates, in the baseline and follow-up periods. Although we cannot conclude a causal relationship between insomnia and healthcare costs, our analysis found that insomnia diagnosis was associated with 26% higher costs in the baseline and 46% in the 12 months after diagnosis. When comorbidities were recognized, the insomnia cohort had 80% higher costs, on average, than the matched control cohort.

Conclusions: These outcomes suggest the need to look beyond the direct cost of insomnia to how its interaction with comorbid conditions drives healthcare cost and utilization.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Case-Control Studies
  • Comorbidity
  • Delivery of Health Care / economics*
  • Delivery of Health Care / statistics & numerical data
  • Female
  • Health Care Costs / statistics & numerical data*
  • Humans
  • Male
  • Managed Care Programs / economics*
  • Managed Care Programs / statistics & numerical data
  • Middle Aged
  • Multivariate Analysis
  • Retrospective Studies
  • Sleep Initiation and Maintenance Disorders / economics*
  • Sleep Initiation and Maintenance Disorders / epidemiology
  • Sleep Initiation and Maintenance Disorders / therapy