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Logo of bmcpsycBioMed Centralsearchsubmit a manuscriptregisterthis articleBMC Psychiatry
 
BMC Psychiatry. 2012; 12: 177.
Published online Oct 23, 2012. doi:  10.1186/1471-244X-12-177
PMCID: PMC3504522
Change in healthcare utilization and costs following initiation of benzodiazepine therapy for long-term treatment of generalized anxiety disorder: a retrospective cohort study
Ariel Berger,corresponding author1 John Edelsberg,1 Michael Treglia,2 Jose Ma J Alvir,2 and Gerry Oster1
1Policy Analysis Inc. (PAI), Brookline, MA, USA
2Pfizer Inc, New York, NY, USA
corresponding authorCorresponding author.
Ariel Berger: aberger/at/pai2.com; John Edelsberg: edelsberg/at/pai2.com; Michael Treglia: Michael.treglia/at/pfizer.com; Jose Ma J Alvir: Jose.Alvir/at/pfizer.com; Gerry Oster: goster/at/pai2.com
Received January 11, 2012; Accepted October 14, 2012.
Abstract
Background
Selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and benzodiazepine anxiolytics are used in the US to treat generalized anxiety disorder (GAD). While benzodiazepines typically provide rapid symptomatic relief, long-term use is not recommended due to risks of dependency, sedation, falls, and accidents.
Methods
Using a US health insurance database, we identified all persons with GAD (ICD-9-CM diagnosis code 300.02) who began a long-term course of treatment (≥90 days) with a benzodiazepine anxiolytic between 1/1/2003 and 12/31/2007, We compared healthcare utilization and costs over the six-month periods preceding and following the date of treatment initiation (“pretreatment” and “post-treatment”, respectively), and focused attention on accident-related encounters (e.g., for treatment of fractures) and care received for other reasons possibly related benzodiazepine use (e.g., sedation, dizziness).
Results
A total of 866 patients met all study entry criteria; 25% of patients began treatment on an add-on basis (i.e., adjunctive to escitalopram, paroxetine, sertraline, or venlafaxine), while 75% of patients did not receive concomitant therapy. Mean total healthcare costs increased by $2334 between the pretreatment and post-treatment periods (from $4637 [SD=$9840] to $6971 [$17,002]; p<0.01); costs of accident-related encounters and other care that was possibly related to use of benzodiazepines increased by an average of $1099 ($1757 [$7656] vs $2856 [$14,836]; p=0.03).
Conclusions
Healthcare costs increase in patients with GAD beginning long-term (≥90 days) treatment with a benzodiazepine anxiolytic; a substantial proportion of this increase is attributable to care associated with accidents and other known sequelae of long-term benzodiazepine use.
Keywords: Anxiety Disorders, Benzodiazepines, Utilization, Costs and Cost Analysis, Healthcare Research
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