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Version 2. F1000Res. 2017 Apr 21 [revised 2017 Jun 28];6:542. doi: 10.12688/f1000research.11328.2. eCollection 2017.

What do hypnotics cost hospitals and healthcare?

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University of California San Diego, La Jolla, CA, 92037-2226, USA.


Hypnotics (sleeping pills) are prescribed widely, but the economic costs of the harm they have caused have been largely unrecognized. Randomized clinical trials have observed that hypnotics increase the incidence of infections. Likewise, hypnotics increase the incidence of major depression and cause emergency admissions for overdoses and deaths.  Epidemiologically, hypnotic use is associated with cancer, falls, automobile accidents, and markedly increased overall mortality.  This article considers the costs to hospitals and healthcare payers of hypnotic-induced infections and other severe consequences of hypnotic use. These are a probable cause of excessive hospital admissions, prolonged lengths of stay at increased costs, and increased readmissions. Accurate information is scanty, for in-hospital hypnotic benefits and risks have scarcely been studied -- certainly not the economic costs of inpatient adverse effects.  Healthcare costs of outpatient adverse effects likewise need evaluation. In one example, use of hypnotics among depressed patients was strongly associated with higher healthcare costs and more short-term disability. A best estimate is that U.S. costs of hypnotic harms to healthcare systems are on the order of $55 billion, but conceivably might be as low as $10 billion or as high as $100 billion. More research is needed to more accurately assess unnecessary and excessive hypnotics costs to providers and insurers, as well as financial and health damages to the patients themselves.


depressive disorders; epidemiology; health care costs; hospital costs; hypnotics and sedatives; infection; mortality; overdose

Conflict of interest statement

Competing interests: The author has no financial interests or conflicts to declare. The author was the Co-Director of Research at the Scripps Clinic Viterbi Family Sleep Center until May, 2016. Since the 1979 publication of hypnotics’ epidemiology from the American Cancer Society CPSI study, the author has been a frequent critic of hypnotics’ risks and benefits, especially through his non-profit internet web site, He has advised the USA Food and Drug Administration to take certain actions to reduce hypnotic risks (Petition available at, and related litigation has arisen to encourage FDA action.

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