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Clinical and Economic Evaluation of Benzodiazepines

A Value Analysis

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Summary

Benzodiazepines are one of the most frequently prescribed classes of medications in the world. Thought to relieve the symptoms of anxiety, insomnia, epilepsy, and some less common conditions, these medications are supported by a body of clinical trials demonstrating efficacy. However, there is also literature that suggests problems of abuse and dependence, along with some serious adverse effects. The present article utilises a value-analysis strategy to outline the clinical efficacy and economic efficiency of benzodiazepines from a variety of perspectives including those of the patient, physician and manufacturer. Results of this analysis suggest that these medications are effective when used appropriately, but that implementation of appropriate use is difficult. Remedies to this situation are discussed.

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References

  • American Medical Association Consensus Conference. Drugs and Insomnia. The use of medications to promote sleep. Journal of the American Medical Association 251: 2408–2414, 1984

    Google Scholar 

  • Arnhoff FN. Social consequences of policy towards mental illness. Science 188: 1277–1281, 1975

    Article  PubMed  CAS  Google Scholar 

  • Avorn J, Soumerai SB. Improving drug-therapy decisions through educational outreach. A randomized controlled trial of academically based, detailing. New England Journal of Medicine, 308: 1457–1463, 1983

    Article  PubMed  CAS  Google Scholar 

  • Ballenger JC. Efficacy of benzodiazepines in panic disorder and agoraphobia. Journal of Psychiatric Research 24: 15–25, 1990

    Article  PubMed  Google Scholar 

  • Balter MB. Continuing special analyses of data from the National Prescription Audit of IMS America, Ambler, PA, 1984

    Google Scholar 

  • Beardsley RS, Gardocki GJ, Larson DB, Hidalgo J. Prescribing of psychotropic medication by primary care physicians and psychiatrists. Archives of General Psychiatry 45: 1117–1119, 1988

    Article  PubMed  CAS  Google Scholar 

  • Beck AT, Sokol L, Clark DA, Berchick R, Wright F. A crossover study of focused cognitive therapy for panic disorder. American Journal of Psychiatry 149: 778–783, 1992

    PubMed  CAS  Google Scholar 

  • Bonfiglio MF, Dasta JF. Clinical significance of the benzodiazepine-theophylline interaction. Pharmacotherapy 11: 85–87, 1991

    PubMed  CAS  Google Scholar 

  • Bovbjerg RR, Hohalan J. Medicaid in the Reagan era: federal policy and state choices. Washington, D.C., Urban Institutes Press, 1982

    Google Scholar 

  • Brahams D. Benzodiazepine overprescribing: successful initiative in New York state. 336: 1372–1373, 1991

    Google Scholar 

  • Brook RH, Ware Jr JE, Rogers WH, Keeler EB, Davies AR, et al. Does free care improve adults’ health? Results from a randomized controlled trial. New England Journal of Medicine 311: 1426–34, 1983

    Article  Google Scholar 

  • Buck AS. Defining quality in health care. Military Medicine 157: 260–262, 1992

    PubMed  CAS  Google Scholar 

  • Burrows GD, Norman TR, Judd FK, Marriott PF. Short-acting versus long-acting benzodiazepines: discontinuation effects in panic disorders. Journal of Psychiatric Research 24: 65–72, 1990

    Article  PubMed  Google Scholar 

  • Buchsbaum DG, Groh MJ, Centor RM. Underdocumentation of benzodiazepine prescriptions in a general medical clinic. Journal of General Internal Medicine 1: 305–308, 1986

    Article  PubMed  CAS  Google Scholar 

  • Carr W, Wolfe S. Unmet needs as social indicators. In Elison J & Sigann AE (Eds) Sociomedical health indicators, pp. 74–91, Baywood, New York, 1979

    Google Scholar 

  • Ciraulo DA, Sands BF, Shader RI. Critical review of liability to benzodiazepine abuse among alcoholics. American Journal of Psychiatry. 145: 1501–1506, 1988

    PubMed  CAS  Google Scholar 

  • Clinthorne JK, Cisin IH, Balter MB, Mellinger GD, Uhlenhuth EH. Changes in popular altitudes and beliefs about tranquilizers. Archives of General Psychiatry 43: 527–532, 1986

    Article  PubMed  CAS  Google Scholar 

  • Collins TM. Multiple copy prescription programs and alternative programs: cost issues. New York State Journal of Medicine 91(Suppl. 11): 28–231, 1991

    Google Scholar 

  • Cook TD, Campbell DT. Field experimentation: quasi-experimental research design. Prentice Hall, New York, 1979

    Google Scholar 

  • Dement W. Overview of the efficacy and safety of benzodiazepine hypnotics using objective methods. Journal of Clinical Psychiatry 52: 27–30, 1991

    PubMed  Google Scholar 

  • DuPont RL. Thinking about stopping treatment for panic disorder. Journal of Clinical Psychiatry 51: 38–45, 1990

    PubMed  Google Scholar 

  • Ensor PA. Projecting future drug expenditures — 1992. American Journal of Hospital Pharmacy 49: 140–145, 1992

    PubMed  CAS  Google Scholar 

  • GAO (General Accounting Office). The elderly remain in need of mental health services. Publication No. GAO/HRD-82-112, Gaithersburg, Maryland, 1982

    Google Scholar 

  • Gaudreault P, Guay J, Thivierge RL, Verdy I. Benzodiazepine poisoning. Clinical and pharmacological considerations and treatment. Safety 6: 247–265, 1991

    Article  CAS  Google Scholar 

  • Glass RM. Benzodiazepine prescription regulation. Autonomy and outcome. Journal of the American Medical Association 260: 2431–2433, 1991

    Article  Google Scholar 

  • Gudex C. Adverse effects of benzodiazepines. Social Science and Medicine 5: 587–596, 1991

    Google Scholar 

  • Hoffman RS, Wipfler MG, Maddaloni MA, Weisman RS. Has the New York state triplicate benzodiazepine prescription regulation influenced sedative-hypnotic overdoses? New York State Journal of Medicine 91: 436–439, 1991

    PubMed  CAS  Google Scholar 

  • Hohmann AA, Larson DB, Thompson JW, Beardsley RS. Psychotropic medication prescription in U.S. ambulatory medical care. Annals of Pharmacotherapy 25: 85–89, 1991

    PubMed  CAS  Google Scholar 

  • Hornbrook MC, Goodman MJ. Managed care: penalties, autonomy, risk, and integration. Primary Care Research: Theory and Methods. U.S. Department of Health and Human Services Proceedings, September, 1991

  • Hochn-Saric R, McLeod DR. Generalized anxiety disorder. Psychiatric clinics of Nonh America 8: 73–89, 1985

    Google Scholar 

  • Howard GS. The role of values in the science of psychology. American Psychologist 39: 833–839, 1985

    Google Scholar 

  • Jenkins R. Towards a system of outcome indicators for mental health care. British Journal of Psychiatry 157: 500–514, 1990

    Article  PubMed  CAS  Google Scholar 

  • Kahneman D, Tversky A. Choices, values, and frames. American Psychologist 39: 341–450, 1984

    Article  Google Scholar 

  • Katon W, Von Korff M, Lin E, Bush T, Ormel J. Adequacy and duration of antidepressant treatment in primary care. Medical Care 30: 67–76, 1992

    Article  PubMed  CAS  Google Scholar 

  • Kimble GA. Psychology’s two cultures. American Psychologist 39: 833–839, 1984

    Article  Google Scholar 

  • Klein DF, Zitrin CM, Woerner MG, Ross DC. Treatment of phobias II. Behavior therapy and supportive psychotherapy. Are there any specific ingredients? Archives of General Psychiatry 40: 139–145, 1983

    Article  PubMed  CAS  Google Scholar 

  • Klosko JS, Barlow DH, Tassinari R, Cerny JA. A comparison of alprazolam and behaviour therapy in treatment of panic disorder. Journal of Consulting and Clinical Psychology 58: 77–84, 1989

    Article  Google Scholar 

  • Larson DB, Lyons JS, Hohmann AA, Beardsley RS, Hidalgo J. Psychotropics prescribed to the US elderly in the early and mid 1980’s: prescribing patterns of primary care practitioners, psychiatrists, and other physicians. International Journal of Geriatric Psychiatry 6: 63–70, 1991

    Article  Google Scholar 

  • Lesser IM. Legal issues and the benzodiazepines. American Journal of Forensic Psychiatry 10: 5–13, 1989

    Google Scholar 

  • Levy R. Prescription cost sharing: economic and health implications for health policy. PharmacoEconomics 2: 219–237, 1992

    Article  PubMed  CAS  Google Scholar 

  • Lindsay WR, Gamsu CV, Mclaughlin E, Hood EM, Espie CA. A controlled trial of treatments for generalized anxiety. British Journal of Clinical Psychology 26: 3–15, 1987

    Article  PubMed  Google Scholar 

  • Linnoila MI. Benzodiazepines and alcohol. Journal of Psychiatric Research 24: 121–127, 1990

    Article  PubMed  Google Scholar 

  • Lyons JS, Hammer JS, Wise TN, Strain JJ. Cost-effectiveness and consultation psychiatry: a review of methods. General Hospital Psychiatry 7: 302–308, 1985

    Article  PubMed  CAS  Google Scholar 

  • Lyons JS, Larson DB. A proposed value matrix for the evaluation of psychiatric consultations in the general hospital. General Hospital Psychiatry 11: 345–351, 1989

    Article  PubMed  CAS  Google Scholar 

  • Lyons JS, Larson DB. Regulations controlling costs of drugs: a perspective from the US. PharmacoEconomics 2: 91–94, 1992

    Article  PubMed  CAS  Google Scholar 

  • Manicas PT, Secord PF. Implications for psychology of a new philosophy of science. American Psychologist 38: 399–413, 1983

    Article  Google Scholar 

  • Mattes JA. The optimal length of hospitalization for psychiatric patients: a review of the literature. Hospital and Community Psychiatry 33: 824–828, 1982

    PubMed  CAS  Google Scholar 

  • McGlynn EA, Norquist GS, Wells KB, Sullivan G, Liberman RP. Quality-of-care research in mental health: responding to the challenge. Inquiry 25: 157–170, 1988

    PubMed  CAS  Google Scholar 

  • Mellinger GD, Balter MB, Uhlenhuth EH. Anti-anxiety agents: duration of use and characteristics of users in the USA. Current Medical Research and Opinion 8: 21–36, 1984a

    Article  PubMed  Google Scholar 

  • Mellinger GD, Balter MB, Uhlenhuth EH. Prevalence and correlates to long-term regular use of anxiolytics. Journal of the American Medical Association 251: 375–379, 1984b

    Article  PubMed  CAS  Google Scholar 

  • Moskowitz H, Smiley A. Effects of chronically administered buspirone and diazepam on driving related skills performance. British Medical Journal 1: 917–919, 1979

    Article  Google Scholar 

  • Olbrisch ME. Psychotherapeutic interventions in physical health: effectiveness and economic efficiency. American Psychologist 32: 761–777, 1977

    Article  PubMed  CAS  Google Scholar 

  • Reernick E. Defining quality of care: mission impossible? Quality Assurance in Health Care 2: 197–202, 1990

    Article  Google Scholar 

  • Rickels K, Case WG, Downing RW, Fridman R. One-year follow up of anxious patients treated with diazepam. Journal of Clinical Psychopharmacology 6: 32–36, 1986

    Article  PubMed  CAS  Google Scholar 

  • Rodriguez RF. The impact of the New York triplicate prescription program on the Hispanic community. New York State Journal of Medicine 91: 24–27, 1991

    Google Scholar 

  • Rosenbloom A. Emerging treatment options in the alcohol withdrawal syndrome. Journal of Clinical Psychiatry 49 (Suppl.): 28–31, 1988

    PubMed  Google Scholar 

  • Schatzberg AF. Benzodiazepines: therapeutic, biological, and psychosocial issues. Journal of Psychiatric Research 24: 1–2, 1990

    Article  PubMed  Google Scholar 

  • Shader RI, Greenblatt DJ, Balter MB. Appropriate use and regulatory control of benzodiazepines. Journal of Clinical Pharmacology 31: 781–784, 1991

    PubMed  CAS  Google Scholar 

  • Sheehan DV. Panic attacks and phobias. New England Journal of Medicine 307: 156–158, 1982

    Article  PubMed  CAS  Google Scholar 

  • Sheehan D, Ballenger JC, Jacobson G. The treatment of endogenous anxiety with phobic. hysterical, and hypochondriacal symptoms, Archives of General Psychiatry 37: 54–59, 1980

    Google Scholar 

  • Shepard DS, Thompson MS. First principles of cost-effectiveness analysis in health. Public Health Reports 94: 535–543, 1979

    PubMed  CAS  Google Scholar 

  • Siu L, Sonnenberg FA, Manning WG, Goldberg CA, Bloomfield ES, et al. Inappropriate use of hospitals in a randomized controlled trial. New England Journal of Medicine 315: 1259–1266, 1986

    Article  PubMed  CAS  Google Scholar 

  • Smith DE, Wesson DR (Eds). Benzodiazepines: current standards for medication practice, MTP Press, Lancaster, 1985

    Google Scholar 

  • Smith Jr GR, Monson RA, Ray DC. Psychiatric consultation in somatization disorder. New England Journal of Medicine 314: 1407–1413, 1986

    Article  PubMed  Google Scholar 

  • Smith Jr GR. Somatization disorder in the medical setting. US Department of Health and Human Services, Publication No. ADM 90-1631, 1990

    Google Scholar 

  • Smith D, Kirking D. The impact of consumer fees on drug utilisation. PharmacoEconomics 2: 335–342, 1992

    Article  PubMed  CAS  Google Scholar 

  • Sofer A. Cost-effective or quality care: which shall it be? Archives of Internal Medicine 145: 1963–1964, 1985

    Article  Google Scholar 

  • Soumerai SB, Avorn J. Economic and policy analysis of university-based drug, detailing. Medical Care 24: 313–331, 1986

    Article  PubMed  CAS  Google Scholar 

  • Soumerai SB, Avorn J, Ross-Degnan D, Gortmaker S. Payment restrictions for prescription drugs under medicaid: effects on therapy. cost, and equity. New England Journal of Medicine 317: 550–556, 1987

    Article  PubMed  CAS  Google Scholar 

  • Soumerai SB, McLaughlin TJ, Avorn J. Improving drug prescribing in primary care: a critical analysis of the experimental literature. Milbank Quarterly Fund 67: 268–317, 1989

    Article  CAS  Google Scholar 

  • Thompson TL, Moran MG, Nies AS. Psychotropic drug use in the elderly. Part 1. New England Journal of Medicine 308: 134–138, 1983

    Article  PubMed  Google Scholar 

  • Uhlenhuth BH, DeWit H, Balter MB, Johanson CE, Mellinger GD. Risks and benefits of long-term benzodiazepine use. Journal of Clinical Psychopharmacology 8: 161–167, 1988

    Article  PubMed  CAS  Google Scholar 

  • Weintraub M, Singh S, Byrne L, Maharaj L, Guttmacher L. Consequences of the 1989 New York state triplicate benzodiazepine prescription regulations. Journal of the American Medical Association 266: 2392–2397, 1991

    Article  PubMed  CAS  Google Scholar 

  • Weissman MM. Panic and generalized anxiety: are they separate disorders? Journal of Psychiatric Research 24: 157–162, 1990

    Article  PubMed  Google Scholar 

  • Williams RB. Do benzodiazepines have a role in the prevention or treatment of coronary heart disease and other major medical disorders? Journal of Psychiatric Research 24: 51–57, 1990

    Article  PubMed  Google Scholar 

  • Wolkowitz OM, Pickar D. Benzodiazepines in the treatment of schizophrenia: a review and reappraisal. American Journal of Psychiatry 148: 714–726, 1991

    PubMed  CAS  Google Scholar 

  • Woods JH, Katz JL, Winger G. Use and abuse of benzodiazepines: issues relevant to prescribing. Journal of the American Medical Association 260: 3474–3480, 1988

    Article  Google Scholar 

  • Yudofsky SC, Silver JM, Hales RE. Pharmacologic management of aggression in the elderly. Journal of Clinical Psychiatry 51: 22–28, 1990

    PubMed  Google Scholar 

  • Zitrin CM, Klein DF, Woerner MG, Ross DC. Treatment of phobias, I. Comparison of imipramine hydrochloride an placebo. Archives of General Psychiatry 40: 125–128, 1983

    Article  PubMed  CAS  Google Scholar 

  • Zorc JJ, Larson DB, Lyons JS, Beardsley RS. Expenditures for psychotropic medications in the United States in 1985. American Journal of Psychiatry 148: 644–647, 1991

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Psychology, Department of Psychiatry and Behavioral Sciences, Ward Building 12-138, Northwestern University Medical School, 303 E. Chicago Avenue, Chicago, IL, 60611-3008, USA

    John S. Lyons

  2. US Department of Health and Human Services, USA

    David B. Larson

  3. Northwestern University, Chicago, Illinois, USA

    Joseph Hromco

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  1. John S. Lyons
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  2. David B. Larson
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  3. Joseph Hromco
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Lyons, J.S., Larson, D.B. & Hromco, J. Clinical and Economic Evaluation of Benzodiazepines. PharmacoEconomics 2, 397–407 (1992). https://doi.org/10.2165/00019053-199202050-00007

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