Journal Article

Cost-effectiveness analysis of lemborexant for treating insomnia in Japan: a model-based projection, incorporating the risk of falls, motor vehicle collisions, and workplace accidents

Inoue, Sachie, Moline, Margaret, Shibahara, Hidetoshi, Azuma, Mie Kasai, Mishima, Kazuo, Ikeda, Shunya, Ishii, Mika, Fujimoto, Kenichi

2022

Overview

Lemborexant 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. A 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. In 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. In a Japanese clinical practice setting, lemborexant may represent a better investment for treating insomnia in the healthcare system in Japan.

• Publisher: Cambridge University Press
• Subject: Accidental Falls / Accidents / Autobiographical literature / Clinical medicine / Clinical research / Clinical trials / Cost analysis / Cost-Benefit Analysis / Cost-Effectiveness Analysis / Costs / Decision making / Diaries / Effectiveness / Falls / Health care / Health care expenditures / Health services / Humans / Insomnia / Japan / Latency / Medical equipment / Medical technology / Melatonin / Motor Vehicles / Occupational safety / Older people / Original / Original Article / Pharmaceuticals / Polysomnography / Quality adjusted life years / Response rates / Robustness / Sensitivity analysis / Sleep / Sleep disorders / Sleep Initiation and Maintenance Disorders / Statistical analysis / Subjectivity / Treatment methods / Treatment outcomes / Uncertainty / Vehicles / Workplace / Workplaces / Zolpidem