Impact of the Medical Policy Intervention for Polypharmacy on Long-Term Prescriptions of Hypnotic Medications in Older Patients: An Interrupted Time-Series Analysis Using a Nationwide Claims Database in Japan.

OBJECTIVE

This study aimed to evaluate the impact of the medical fee revisions related to polypharmacy in Japan on the long-term hypnotic prescriptions in older patients.

METHODS

We utilized the JMDC medical institution database. Outpatients and inpatients aged ≥ 50 years were included. The target hypnotics included benzodiazepines (BZDs), z-drugs, and ramelteon and orexin receptor antagonists (ramelteon/ORAs). The incidence rates of the newly initiated ≥ 4 weeks of prescriptions per 10 000 outpatients and inpatients (LP-rate) in each month from 2015 to 2022 were calculated. An interrupted time-series analysis was conducted with the intervention point of April 2020 when the medical fees were revised.

RESULTS

The average number of outpatients and inpatients in the database from 2015 to 2022 was 828,510/month. The LP-rates of BZDs and z-drugs gradually decreased from 210 to 125 and 111 to 78.6, respectively, from January 2015 to December 2022, whereas that of ramelteon/ORAs increased from 7.41 to 54.4. In the LP-rate of BZDs and z-drugs, although the level significantly increased by factors of 1.08 [95% confidence interval (CI): 1.02-1.13] and 1.12 [95% CI: 1.08-1.16], respectively, at the intervention time, the slope change significantly decreased after the intervention (0.990 [95% CI: 0.988-0.992] and 0.994 [95% CI: 0.993-0.996]). In ramelteon/ORAs, the slope change with the increasing trend was significantly attenuated after the intervention (0.991 [95% CI: 0.986-0.995]).

CONCLUSIONS

The medical fee revisions related to polypharmacy significantly redirected the long-term prescription trends of BZDs, z-drugs, and ramelteon/ORAs toward a decline.