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Twelve-year trend in the use of zolpidem and physicians’ non-compliance with recommended duration: a Korean national health insurance database study

  • Pharmacoepidemiology and Prescription
  • Published:
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Abstract

Objectives

Abuse of zolpidem has sporadically been reported and little is known regarding nationwide patterns of zolpidem use in Korea. This study investigates the extent of zolpidem usage exceeding the recommended duration and the predictors.

Methods

We conducted a drug utilization study using the national sample cohort database of the Korea National Health Insurance Corporation between 2002 and 2013. The study subjects were patients treated with zolpidem in the outpatient setting. An episode was defined as a period of continuous zolpidem therapy. The provider-based episode allowed for a gap of up to 3 days between two consecutive prescriptions from the same institution. The person-based episode allowed for a gap of up to 3 days, regardless of institution. We calculated the proportion of zolpidem use for periods over 30 days and conducted logistic regression analyses to investigate the relevant predictors. An adjusted odds ratio (aOR) with a 95% confidence interval (CI) was estimated for each predictor.

Results

The usage of zolpidem is dramatically increased by approximately 18 times since zolpidem was authorized in the market (1181 in 2002 vs. 21,399 in 2013). The treatment duration in 8.3% of episodes exceeded 30 days out of 75,087 zolpidem users. The odds of zolpidem prescription exceeding 30 days were highest in patients aged 65 years and older (aOR = 2.13, 95% CI 1.78–2.53) and at tertiary hospitals (aOR = 2.14, 95% CI 1.68–2.72). Women were more likely than men to be treated with zolpidem for over 30 days.

Conclusion

We found dramatic increase of zolpidem use from 2002 to 2013. In 8.3% of the prescribed episodes of zolpidem, the recommended duration was exceeded. Efforts are required to reduce prescriptions that are inconsistent with the recommended guidelines for older patients, women, and in tertiary hospitals.

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Acknowledgements

This study used National Health Insurance Service (NHIS)—National Sample Cohort data (REQ0000006111) made available by the NHIS.

Funding

This research was supported by Korea-Canada Cooperative Development Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science and ICT (MSIT) (No.2017K1A3A1A12073341).

Author information

Authors and Affiliations

  1. School of Pharmacy, Sungkyunkwan University, Suwon, South Korea

    Yunjeung Jang, Inmyung Song, In-Sun Oh & Ju-Young Shin

Authors
  1. Yunjeung Jang
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  2. Inmyung Song
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  3. In-Sun Oh
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  4. Ju-Young Shin
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Corresponding author

Correspondence to Ju-Young Shin.

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The authors declare that they have no conflict of interest.

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Key points

1. The usage of zolpidem is dramatically increased by approximately 18 times since zolpidem was authorized in the market (1181 in 2002 vs. 21,399 in 2013).

2. Reimbursement guidelines in Korea recommend that zolpidem is used for a maximum duration of 30 days.

3. Zolpidem was prescribed for over 30 days in 8.3% of treatment episodes.

4. The odds of zolpidem prescription for over 30 days were higher for older patients, women, and prescriptions from tertiary hospitals.

5. The odds of zolpidem prescription for over 30 days were higher for the immediate release form than the controlled release form.

Yunjeung Jang and Inmyung Song are Co-first author

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Jang, Y., Song, I., Oh, IS. et al. Twelve-year trend in the use of zolpidem and physicians’ non-compliance with recommended duration: a Korean national health insurance database study. Eur J Clin Pharmacol 75, 109–117 (2019). https://doi.org/10.1007/s00228-018-2563-9

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  • DOI: https://doi.org/10.1007/s00228-018-2563-9

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