Impact of the Medical Policy Intervention for Polypharmacy on Long‐Term Prescriptions of Hypnotic Medications in Older Patients: An Interrupted Time‐Series Analysis Using a Nationwide Claims Database in Japan

OBJECTIVE: This study aimed to evaluate the impact of the medical fee revisions related to polypharmacy in Japan on the long-term hypnotic prescriptions in older patients. METHODS: We utilized the JMDC medical institution database. Outpatients and inpatients aged ≥ 50 years were included. The target hypnotics included benzodiazepines (BZDs), z-drugs, and ramelteon and orexin receptor antagonists (ramelteon/ORAs). The incidence rates of the newly initiated ≥ 4 weeks of prescriptions per 10 000 outpatients and inpatients (LP-rate) in each month from 2015 to 2022 were calculated. An interrupted time-series analysis was conducted with the intervention point of April 2020 when the medical fees were revised. RESULTS: The average number of outpatients and inpatients in the database from 2015 to 2022 was 828,510/month. The LP-rates of BZDs and z-drugs gradually decreased from 210 to 125 and 111 to 78.6, respectively, from January 2015 to December 2022, whereas that of ramelteon/ORAs increased from 7.41 to 54.4. In the LP-rate of BZDs and z-drugs, although the level significantly increased by factors of 1.08 [95% confidence interval (CI): 1.02-1.13] and 1.12 [95% CI: 1.08-1.16], respectively, at the intervention time, the slope change significantly decreased after the intervention (0.990 [95% CI: 0.988-0.992] and 0.994 [95% CI: 0.993-0.996]). In ramelteon/ORAs, the slope change with the increasing trend was significantly attenuated after the intervention (0.991 [95% CI: 0.986-0.995]). CONCLUSIONS: The medical fee revisions related to polypharmacy significantly redirected the long-term prescription trends of BZDs, z-drugs, and ramelteon/ORAs toward a decline.