Modelled savings top $13,000 per person versus older pills
Newer insomnia drugs could save society more than $13,000 per person yearly versus older sleep medications, a new Signal49 Research report says.
The report, released Tuesday, looked at dual orexin receptor antagonists (DORAs). It compared them with benzodiazepines and Z-drugs using a 12-month cost-consequence model. The model tracked productivity, workplace and motor vehicle accidents, falls, hip fractures, healthcare use and drug costs.
What the report found
Chronic insomnia affects about 10% of Canadians, the report says. It estimates an annual economic burden of $1.9 billion. It links chronic insomnia to lost productivity and injury-related events.
Cognitive behavioural therapy for insomnia (CBT-I) is widely recommended as a first-line treatment. Access barriers often limit it, so many patients keep relying on drugs.
Key modelled results:
- Productivity: Annual losses among working-age adults were about $12,000 per person with DORAs. They were about $20,000 with benzodiazepines and more than $16,000 with Z-drugs.
- Net savings: Savings reached $16,706 per person a year versus benzodiazepines and $13,161 versus Z-drugs.
- Drug costs: DORAs cost more to acquire, but the report says savings elsewhere may partly or fully offset that.
- Safety: DORAs were linked to lower costs from motor vehicle accidents, workplace accidents, falls and hip fractures. The gaps were largest among older adults, where lower hip fracture risk meant substantial reductions in hospitalization and wage-loss costs.
The report also drew on interviews with patients, clinicians and public funders. Participants cited fragmented care and limited access to behavioural therapies. They also pointed to reimbursement frameworks built around legacy treatments.
Clinicians said affordability and coverage limits often shape which drug they prescribe. The report says treatment patterns follow access limits, reimbursement rules and prescribing habits, not clinical appropriateness alone. It calls for better alignment between clinical evidence, care pathways and reimbursement.
Coverage reality for plan sponsors
Public reimbursement remains a hurdle. Canada’s Drug Agency issued a final “do not reimburse” recommendation for daridorexant in October 2025. It issued the same for lemborexant in January 2026.
For lemborexant, the agency said it was uncertain whether the drug offers meaningful clinical benefit over other treatments. These recommendations are non-binding and guide public plans outside Quebec, according to the agency.
Private plans decide their own coverage. A 2024 study of mostly private drug plan claims found inappropriate insomnia drug use in 52.5% of adults and 69.5% of seniors in 2019. The same study put annual insomnia drug spending at $54.8 million, with 55.2% meeting inappropriate-use criteria. It was sponsored by Eisai, which makes lemborexant.
Benefits advisers may find the report useful for weighing drug claim costs against disability, absence and fracture-related costs. The report’s savings are societal, so they may not land with the plan paying the drug claim.
Plan sponsors might also review access to behavioural therapy, which the report describes as limited. Hip fracture findings could matter for retiree benefits.
The figures are modelled estimates, not claims results. Advisers may want to confirm the model’s assumptions with Signal49 before relying on them. The release does not say who funded the report.
