Abstract
AbstractBackgroundLemborexant has demonstrated statistically significant improvements in sleep onset and sleep maintenance compared with placebo and zolpidem tartrate extended release, measured both objectively using polysomnography and subjectively using sleep diaries, in the phase 3 clinical trial SUNRISE 1. This study evaluated the cost-effectiveness of lemborexant compared with suvorexant, zolpidem immediate release (IR), and untreated insomnia.MethodsA decision-tree model was developed for falls, motor vehicle collisions, and workplace accidents associated with insomnia and insomnia treatments from a Japanese healthcare perspective and with a 6-month time horizon. The model extracted subjective sleep onset latency treatment responses and disutility values for non-responders from SUNRISE 1. Cost-effectiveness was assessed using incremental cost per quality-adjusted life year (QALY) gained. One-way and probabilistic sensitivity analyses were conducted to evaluate the impact of parameter uncertainty on the results.ResultsIn the base-case analysis, the mean estimated QALYs for lemborexant, suvorexant, zolpidem-IR, and untreated insomnia were 0.4220, 0.4204, 0.4113, and 0.4163, and expected medical costs were JPY 34 034, JPY 38 371, JPY 38 139, and JPY 15 383, respectively. Lemborexant saved JPY 4337 and JPY 4105 compared with suvorexant or zolpidem-IR, respectively, while conferring QALY benefits. The incremental cost-effectiveness ratio (ICER) of lemborexant compared with that of untreated insomnia was JPY 3 220 975 /QALY. Lemborexant was dominant over suvorexant and zolpidem-IR and was cost-effective when compared with untreated insomnia. Sensitivity analyses supported the results' robustness.ConclusionsIn a Japanese clinical practice setting, lemborexant may represent a better investment for treating insomnia in the healthcare system in Japan.
Publisher
Cambridge University Press (CUP)
Subject
Psychiatry and Mental health,Applied Psychology
Reference57 articles.
1. MHLW(Ministry of Health, Labour and Welfare). (2019). Patient survey 2017. Retrieved from https://www.mhlw.go.jp/toukei/saikin/hw/kanja/17/index.html.
2. Lemborexant vs suvorexant for insomnia: A systematic review and network meta-analysis
3. Respiratory safety of lemborexant in healthy adult and elderly subjects with mild obstructive sleep apnea: A randomized, double‐blind, placebo‐controlled, crossover study
4. Japanese population norms for preference-based measures: EQ-5D-3L, EQ-5D-5L, and SF-6D
5. PMDA (Pharmaceuticals and Medical Devices Agency). (2017). PMDA alert for proper use of drugs: Dependence associated with Benzodiazepine Receptor Agonists. Retrieved from https://www.pmda.go.jp/files/000217228.pdf.