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Addiction
Original research
Patterns of benzodiazepine prescription among older adults in Switzerland: a cross-sectional analysis of claims data
  1. Xhyljeta Luta1,
  2. Christophe Bagnoud2,
  3. Mark Lambiris3,
  4. Anne Decollogny1,
  5. Yves Eggli1,
  6. Marie-Annick Le Pogam1,
  7. Pedro Marques-Vidal4,
  8. Joachim Marti1
  1. 1 Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
  2. 2 Groupe Mutuel, Martigny, Switzerland
  3. 3 Swiss Tropical and Public Health Institute, Basel, Switzerland
  4. 4 Department of Internal Medicine, Lausanne University Hospital, Lausanne, Vaud, Switzerland
  1. Correspondence to Professor Joachim Marti; joachim.marti{at}unisante.ch

Abstract

Objective This study aimed to examine the prevalence and determinants of benzodiazepine prescription among older adults in Switzerland, and analyse association with hospitalisation and costs.

Design Retrospective analysis of claims data.

Setting The study was conducted in nine cantons in Switzerland.

Participants Older adults aged 65 years and older enrolled with a large Swiss health insurance company participated in the study.

Primary and secondary outcome measures The primary outcome was prevalence of benzodiazepine prescription. The secondary outcomes were (1) determinants of any benzodiazepine prescription; (2) the association between any prescription and the probability of hospitalisation for trauma and (3) the association between any prescription and total healthcare expenditures.

Results Overall, 69 005 individuals were included in the study. Approximately 20% of participants had at least one benzodiazepine prescription in 2017. Prescription prevalence increased with age (65–69: 15.9%; 70–74: 18.4%; 75–80: 22.5%; >80: 25.8%) and was higher in women (25.1%) compared with men (14.6%). Enrollees with the highest deductible of Swiss Francs (CHF) 2500 were 70% less likely to receive a prescription than enrollees with the lowest deductible of CHF 300 (adjusted OR=0.29, 95% CI 0.24 to 0.35).

Individuals with at least one prescription had a higher probability of hospitalisation for trauma (OR=1.31, 95% CI 1. 20 to 1.1.44), and 70% higher health care expenditures (β=0.72, 95% CI 0. 67 to 0.77). Enrollees in canton Valais were three times more likely to receive a prescription compared to enrollees from canton Aargau (OR=2.84, 95% 2.51 to 3.21).

Conclusions The proportion of older adults with at least one benzodiazepine prescription is high, as found in the data of one large Swiss health insurance company. These enrollees are more likely to be hospitalised for trauma and have higher healthcare expenditures. Important differences in prescription prevalence across cantons were observed, suggesting potential overuse. Further research is needed to understand the drivers of variation, prescription patterns across providers, and trends over time.

  • benzodiazepine use
  • prescription
  • older adults
  • claims data
  • hospitalisations
  • costs
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2019-031156

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    Footnotes

    • Twitter @xluta

    • Contributors JM was the principal investigator on the project and led the analyses. CB actively collaborated on data preparation, description, analysis and interpretation. ML and CB were involved in data management. XL and JM drafted the manuscript. AD, YE, M-ALP and PM-V provided input in the analysis phase. All authors provided critical feedback and approved the final version of the manuscript.

    • Funding This work was supported by the Swiss Medical Board (www.medical-board.ch).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval In our analysis we used routinely collected anonymous data; therefore, ethical approval was not required according to the Swiss law for research on humans.30

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement The insurance claims data cannot be made publicly available.