The Experts below are selected from a list of 33411 Experts worldwide ranked by ideXlab platform
Helen-maria Vasiliadis - One of the best experts on this subject based on the ideXlab platform.
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Sedative-Hypnotic Medicines and Falls in Community-Dwelling Older Adults: A Cost-Effectiveness (Decision-Tree) Analysis from a US Medicare Perspective
Drugs & Aging, 2015Co-Authors: Cara Tannenbaum, Vakaramoko Diaby, Mireille Luc, Dharmender Singh, Sylvie Perreault, Helen-maria VasiliadisAbstract:BackgroundBoth the 2012 Beers list and the American Geriatric Society ‘Choosing Wisely’ campaign suggest restraint in the use of sedative-Hypnotics for the treatment of insomnia in older people. Sedative hypnotic agents continue to be widely prescribed even though their use in the elderly is associated with an increased risk of falls, fractures, and emergency hospitalizations.ObjectiveThe aim of this study was to estimate the cost effectiveness of cognitive behavioral therapy (CBT) compared with sedative-Hypnotics and no treatment for insomnia in the US Medicare population, adjusting for the risk of falls and related consequences.MethodsA model-based economic evaluation (decision tree) using the US Medicare perspective and a conservative annual temporal framework was conducted. Simulations were performed in a hypothetical cohort of Medicare beneficiaries suffering from insomnia. The main outcome measure was the incremental cost per quality-adjusted life year (QALY) gained. Sensitivity analyses assessed the robustness of the base-case analysis.ResultsOn an annual basis, CBT showed a dominance (cost: US$19,442; QALYs: 0.594) over sedative Hypnotics (cost: US$32,452; QALYs: 0.552) and no treatment (cost: US$33,853; QALYs: 0.517). Assuming a willingness to pay of US$50,000, the net monetary benefit was positive for CBT (US$10,287) and negative for sedative Hypnotics (−US$4,851) and no treatment (−US$7,993). CBT had a 95 % chance of being the dominant strategy, with results most sensitive to an older adult’s baseline risk of falling.ConclusionFailure to consider drug harms such as drug-induced falls and hospitalization represents a growing public health concern, significantly underestimating the cost of sedative-hypnotic therapy and loss in quality of life for the elderly. Public payers should reconsider reimbursement of sedative-hypnotic drugs as first-line treatment for insomnia in older adults.
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sedative hypnotic medicines and falls in community dwelling older adults a cost effectiveness decision tree analysis from a us medicare perspective
Drugs & Aging, 2015Co-Authors: Cara Tannenbaum, Vakaramoko Diaby, Mireille Luc, Helen-maria Vasiliadis, Dharmender Singh, Sylvie PerreaultAbstract:Background Both the 2012 Beers list and the American Geriatric Society ‘Choosing Wisely’ campaign suggest restraint in the use of sedative-Hypnotics for the treatment of insomnia in older people. Sedative hypnotic agents continue to be widely prescribed even though their use in the elderly is associated with an increased risk of falls, fractures, and emergency hospitalizations.
Isabelle Jaussent - One of the best experts on this subject based on the ideXlab platform.
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Hypnotics and mortality in an elderly general population: a 12-year prospective study.
BMC Medicine, 2013Co-Authors: Isabelle Jaussent, Marie-laure Ancelin, Claudine Berr, Karine Pérès, Jacqueline Scali, Alain Besset, Karen Ritchie, Yves DauvilliersAbstract:BACKGROUND: Hypnotics are widely used by the elderly, and their impact on mortality remains controversial. The inconsistent findings could be due to methodological limitations, notably the lack of control for underlying sleep symptoms or illness associated with hypnotic use, for example, insomnia symptoms and excessive daytime sleepiness, depression and anxiety. Our objective was to examine the association between the use of Hypnotics and mortality risk in a large cohort of community-dwelling elderly, taking into account a wide range of potential competing risks including sociodemographic characteristics, lifestyle, and chronic disorders as well as underlying psychiatric disorders and sleep complaints. METHODS: Analyses were carried out on 6,696 participants aged 65 years or older randomly recruited from three French cities and free of dementia at baseline. Adjusted Cox proportional hazards models with delayed entry, and age of the participants as the time scale, were used to determine the association between hypnotic use and 12-year survival. RESULTS: At baseline, 21.7% of the participants regularly used at least one hypnotic. During follow-up, 1,307 persons died, 480 from cancer and 344 from cardiovascular disease. Analyses adjusted for study center, age and gender showed a significantly greater risk of all-cause and cardiovascular-related mortality with Hypnotics, particularly benzodiazepines, and this increased with the number of Hypnotics used. None of these associations were significant in models adjusting for sociodemographic and lifestyle characteristics, chronic disorders including cardiovascular pathologies, sleep and psychiatric disorders. Results remained unchanged when duration of past hypnotic intake or persistent versus intermittent use during follow-up were taken into account. CONCLUSIONS: When controlling for a large range of potential confounders, the risk of mortality was not significantly associated with hypnotic use regardless of the type and duration. Underlying psychiatric disorders appear to be the principal confounders of the observed association.
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Hypnotics and mortality in an elderly general population a 12 year prospective study
BMC Medicine, 2013Co-Authors: Isabelle Jaussent, Marie-laure Ancelin, Claudine Berr, Karine Pérès, Jacqueline Scali, Alain BessetAbstract:Background Hypnotics are widely used by the elderly, and their impact on mortality remains controversial. The inconsistent findings could be due to methodological limitations, notably the lack of control for underlying sleep symptoms or illness associated with hypnotic use, for example, insomnia symptoms and excessive daytime sleepiness, depression and anxiety. Our objective was to examine the association between the use of Hypnotics and mortality risk in a large cohort of community-dwelling elderly, taking into account a wide range of potential competing risks including sociodemographic characteristics, lifestyle, and chronic disorders as well as underlying psychiatric disorders and sleep complaints.
Cara Tannenbaum - One of the best experts on this subject based on the ideXlab platform.
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Sedative-Hypnotic Medicines and Falls in Community-Dwelling Older Adults: A Cost-Effectiveness (Decision-Tree) Analysis from a US Medicare Perspective
Drugs & Aging, 2015Co-Authors: Cara Tannenbaum, Vakaramoko Diaby, Mireille Luc, Dharmender Singh, Sylvie Perreault, Helen-maria VasiliadisAbstract:BackgroundBoth the 2012 Beers list and the American Geriatric Society ‘Choosing Wisely’ campaign suggest restraint in the use of sedative-Hypnotics for the treatment of insomnia in older people. Sedative hypnotic agents continue to be widely prescribed even though their use in the elderly is associated with an increased risk of falls, fractures, and emergency hospitalizations.ObjectiveThe aim of this study was to estimate the cost effectiveness of cognitive behavioral therapy (CBT) compared with sedative-Hypnotics and no treatment for insomnia in the US Medicare population, adjusting for the risk of falls and related consequences.MethodsA model-based economic evaluation (decision tree) using the US Medicare perspective and a conservative annual temporal framework was conducted. Simulations were performed in a hypothetical cohort of Medicare beneficiaries suffering from insomnia. The main outcome measure was the incremental cost per quality-adjusted life year (QALY) gained. Sensitivity analyses assessed the robustness of the base-case analysis.ResultsOn an annual basis, CBT showed a dominance (cost: US$19,442; QALYs: 0.594) over sedative Hypnotics (cost: US$32,452; QALYs: 0.552) and no treatment (cost: US$33,853; QALYs: 0.517). Assuming a willingness to pay of US$50,000, the net monetary benefit was positive for CBT (US$10,287) and negative for sedative Hypnotics (−US$4,851) and no treatment (−US$7,993). CBT had a 95 % chance of being the dominant strategy, with results most sensitive to an older adult’s baseline risk of falling.ConclusionFailure to consider drug harms such as drug-induced falls and hospitalization represents a growing public health concern, significantly underestimating the cost of sedative-hypnotic therapy and loss in quality of life for the elderly. Public payers should reconsider reimbursement of sedative-hypnotic drugs as first-line treatment for insomnia in older adults.
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sedative hypnotic medicines and falls in community dwelling older adults a cost effectiveness decision tree analysis from a us medicare perspective
Drugs & Aging, 2015Co-Authors: Cara Tannenbaum, Vakaramoko Diaby, Mireille Luc, Helen-maria Vasiliadis, Dharmender Singh, Sylvie PerreaultAbstract:Background Both the 2012 Beers list and the American Geriatric Society ‘Choosing Wisely’ campaign suggest restraint in the use of sedative-Hypnotics for the treatment of insomnia in older people. Sedative hypnotic agents continue to be widely prescribed even though their use in the elderly is associated with an increased risk of falls, fractures, and emergency hospitalizations.
Alain Besset - One of the best experts on this subject based on the ideXlab platform.
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Hypnotics and mortality in an elderly general population: a 12-year prospective study.
BMC Medicine, 2013Co-Authors: Isabelle Jaussent, Marie-laure Ancelin, Claudine Berr, Karine Pérès, Jacqueline Scali, Alain Besset, Karen Ritchie, Yves DauvilliersAbstract:BACKGROUND: Hypnotics are widely used by the elderly, and their impact on mortality remains controversial. The inconsistent findings could be due to methodological limitations, notably the lack of control for underlying sleep symptoms or illness associated with hypnotic use, for example, insomnia symptoms and excessive daytime sleepiness, depression and anxiety. Our objective was to examine the association between the use of Hypnotics and mortality risk in a large cohort of community-dwelling elderly, taking into account a wide range of potential competing risks including sociodemographic characteristics, lifestyle, and chronic disorders as well as underlying psychiatric disorders and sleep complaints. METHODS: Analyses were carried out on 6,696 participants aged 65 years or older randomly recruited from three French cities and free of dementia at baseline. Adjusted Cox proportional hazards models with delayed entry, and age of the participants as the time scale, were used to determine the association between hypnotic use and 12-year survival. RESULTS: At baseline, 21.7% of the participants regularly used at least one hypnotic. During follow-up, 1,307 persons died, 480 from cancer and 344 from cardiovascular disease. Analyses adjusted for study center, age and gender showed a significantly greater risk of all-cause and cardiovascular-related mortality with Hypnotics, particularly benzodiazepines, and this increased with the number of Hypnotics used. None of these associations were significant in models adjusting for sociodemographic and lifestyle characteristics, chronic disorders including cardiovascular pathologies, sleep and psychiatric disorders. Results remained unchanged when duration of past hypnotic intake or persistent versus intermittent use during follow-up were taken into account. CONCLUSIONS: When controlling for a large range of potential confounders, the risk of mortality was not significantly associated with hypnotic use regardless of the type and duration. Underlying psychiatric disorders appear to be the principal confounders of the observed association.
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Hypnotics and mortality in an elderly general population a 12 year prospective study
BMC Medicine, 2013Co-Authors: Isabelle Jaussent, Marie-laure Ancelin, Claudine Berr, Karine Pérès, Jacqueline Scali, Alain BessetAbstract:Background Hypnotics are widely used by the elderly, and their impact on mortality remains controversial. The inconsistent findings could be due to methodological limitations, notably the lack of control for underlying sleep symptoms or illness associated with hypnotic use, for example, insomnia symptoms and excessive daytime sleepiness, depression and anxiety. Our objective was to examine the association between the use of Hypnotics and mortality risk in a large cohort of community-dwelling elderly, taking into account a wide range of potential competing risks including sociodemographic characteristics, lifestyle, and chronic disorders as well as underlying psychiatric disorders and sleep complaints.
Claudine Berr - One of the best experts on this subject based on the ideXlab platform.
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Hypnotics and mortality in an elderly general population: a 12-year prospective study.
BMC Medicine, 2013Co-Authors: Isabelle Jaussent, Marie-laure Ancelin, Claudine Berr, Karine Pérès, Jacqueline Scali, Alain Besset, Karen Ritchie, Yves DauvilliersAbstract:BACKGROUND: Hypnotics are widely used by the elderly, and their impact on mortality remains controversial. The inconsistent findings could be due to methodological limitations, notably the lack of control for underlying sleep symptoms or illness associated with hypnotic use, for example, insomnia symptoms and excessive daytime sleepiness, depression and anxiety. Our objective was to examine the association between the use of Hypnotics and mortality risk in a large cohort of community-dwelling elderly, taking into account a wide range of potential competing risks including sociodemographic characteristics, lifestyle, and chronic disorders as well as underlying psychiatric disorders and sleep complaints. METHODS: Analyses were carried out on 6,696 participants aged 65 years or older randomly recruited from three French cities and free of dementia at baseline. Adjusted Cox proportional hazards models with delayed entry, and age of the participants as the time scale, were used to determine the association between hypnotic use and 12-year survival. RESULTS: At baseline, 21.7% of the participants regularly used at least one hypnotic. During follow-up, 1,307 persons died, 480 from cancer and 344 from cardiovascular disease. Analyses adjusted for study center, age and gender showed a significantly greater risk of all-cause and cardiovascular-related mortality with Hypnotics, particularly benzodiazepines, and this increased with the number of Hypnotics used. None of these associations were significant in models adjusting for sociodemographic and lifestyle characteristics, chronic disorders including cardiovascular pathologies, sleep and psychiatric disorders. Results remained unchanged when duration of past hypnotic intake or persistent versus intermittent use during follow-up were taken into account. CONCLUSIONS: When controlling for a large range of potential confounders, the risk of mortality was not significantly associated with hypnotic use regardless of the type and duration. Underlying psychiatric disorders appear to be the principal confounders of the observed association.
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Hypnotics and mortality in an elderly general population a 12 year prospective study
BMC Medicine, 2013Co-Authors: Isabelle Jaussent, Marie-laure Ancelin, Claudine Berr, Karine Pérès, Jacqueline Scali, Alain BessetAbstract:Background Hypnotics are widely used by the elderly, and their impact on mortality remains controversial. The inconsistent findings could be due to methodological limitations, notably the lack of control for underlying sleep symptoms or illness associated with hypnotic use, for example, insomnia symptoms and excessive daytime sleepiness, depression and anxiety. Our objective was to examine the association between the use of Hypnotics and mortality risk in a large cohort of community-dwelling elderly, taking into account a wide range of potential competing risks including sociodemographic characteristics, lifestyle, and chronic disorders as well as underlying psychiatric disorders and sleep complaints.