This study aimed to characterize the incremental healthcare burden of insomnia among patients with Alzheimer’s disease dementia (AD) with or without depression using real-world data.

Insomnia is associated with worsened clinical outcomes among AD patients, increased prevalence of depression, and is associated with increased healthcare utilization. This study explores the effects of insomnia on healthcare utilization and costs among AD patients with or without depression.

A retrospective observational study was conducted on AD patients (diagnosed 1/1/15-12/31/17) selected from the IBM® MarketScan Commercial and Medicare Supplemental Databases. Patients were stratified based on claims-based evidence of insomnia (medication or diagnosis; first relevant insomnia claim = index date for the insomnia sub-cohort). Patients without insomnia were direct matched (up to 3:1) to the AD+insomnia cohort based on age, sex, region, and year of AD diagnosis. Non-insomnia patients were assigned index dates based on the distribution of days between insomnia index dates and AD diagnosis dates. Cohorts were stratified by the presence of a diagnosis for depression within 12 months preceding the index date. Outcomes were measured in the 12-months following the index date and compared via bivariate analyses.

Of 3,500 AD+insomnia patients identified, 39.5% had comorbid depression, significantly higher than the proportion among AD patients without insomnia (24.9%) (p<0.001), which may contribute to the higher costs among AD+insomnia patients vs. non-insomnia AD patients (Median follow-up healthcare costs: $18,813 vs. $12,318; p<0.001). AD patients with baseline depression showed a large incremental cost burden associated with insomnia ($20,594 vs. $14,877; p=0.002), as did AD patients without depression ($17,875 vs. $11,652; p<0.001). Skilled nursing services were more common in AD+insomnia patients regardless of underlying depression status.

Insomnia leads to incremental healthcare burden regardless of the presence or absence of depression. Treating insomnia is an important part of AD disease management.