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BMJ Open. 2020 Jan 6;10(1):e031156. doi: 10.1136/bmjopen-2019-031156.

Patterns of benzodiazepine prescription among older adults in Switzerland: a cross-sectional analysis of claims data.

Author information

1
Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
2
Groupe Mutuel, Martigny, Switzerland.
3
Swiss Tropical and Public Health Institute, Basel, Switzerland.
4
Department of Internal Medicine, Lausanne University Hospital, Lausanne, Vaud, Switzerland.
5
Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland joachim.marti@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.

KEYWORDS:

benzodiazepine use; claims data; costs; hospitalisations; older adults; prescription

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