J. Menzin et al., A general model of the effects of sleep medications on the risk and cost of motor vehicle accidents and its application to France, PHARMACOECO, 19(1), 2001, pp. 69-78
Background: Although various prescription drugs may be equally effective in
promoting sleep, some may lead to substantial impairment in psychomotor fu
nctioning and an increased risk of motor vehicle accidents.
Objective: To develop a general model to evaluate the potential effects of
sleep medications on motor vehicle accidents and costs, and apply the model
to the French setting.
Methods: Impairment in driving performance, as evaluated by randomised cont
rolled open-road studies using the standard deviation of a vehicle's latera
l position (SDLP), a measure of weaving, was expressed in terms of equivale
nt blood alcohol (ethanol) concentration (BAC). Epidemiological data were t
hen used to relate BAC to the excess risk of motor vehicle accidents. Altho
ugh a non-impairing medication would not increase risk, a medication that p
roduces mild impairment in driving performance (a change of 2.5cm in SDLP,
equivalent to 0.05% BAG) would increase motor vehicle accident risk by 25%.
One that leads to moderate impairment (an SDLP change of 4.5cm, equivalent
to 0.08% BAG) would roughly double this risk, and a severely impairing med
ication (an SDLP change of 7cm, equivalent to 0.12% BAG) would result in up
to a 5-fold increase in motor vehicle accident risk. For application to th
e French setting, a hypothetical cohort of 100 000 adult drivers with insom
nia was assumed to be treated for 14 days either with zaleplon 10mg, a new
sleep medication that has been shown not to significantly impair driving pe
rformance, or zopiclone 7.5mg, which has been shown to cause moderate impai
rment.
Results: Compared with zaleplon, use of zopiclone over 14 days in France wo
uld be expected to result in 503 excess accidents per 100 000 drivers at an
additional cost of 158 French francs (31 US dollars) per person (1996 valu
es).
Conclusions: Our model illustrates the extent to which non-impairing sleep
medications could reduce the burden posed by motor vehicle accidents. Our m
odel is designed to be general, and thus can serve as the basis for similar
investigations.