Bruce Wong

Impact of Early Nonadherence to Oral Antipsychotics on Clinical and Economic Outcomes Among Patients with Schizophrenia

IntroductionTo quantify early nonadherence to antipsychotic medications in patients with schizophrenia and its impact on short-term antipsychotic adherence, healthcare utilization, and costs.MethodsPatients who initiated oral antipsychotic treatment between January 1, 2006 to September 30, 2009 were identified from the MarketScan®Commercial Claims and Encounters (CCE) database (Truven Health Analytics, Ann Arbor, Michigan, USA). Patients were required to have a diagnosis of schizophrenia determined by the International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) code 295.x, be 13–65 years of age, and have ≥12 months of continuous coverage prior to and after (follow-up) the earliest antipsychotic usage (index event). Medication discontinuation was defined as a gap of 30 days in available therapy; early nonadherence was defined as having the gap 90 days from the index event. During the follow-up period, medication adherence was estimated with quarterly medication possession ratios (MPR), and all-cause and schizophrenia-related healthcare resource utilization and costs were determined.ResultsThe mean time to discontinuation (TTD) was 39.5 ± 20.1 days for early nonadherence patients (n = 873) and 250.7 ± 103.3 days for patients who were adherent early (n = 589). Early nonadherence resulted in more hospitalizations (0.57 vs. 0.38; P = 0.0006) with longer length of stay (LOS, 5.0 vs. 3.0 days; P = 0.0013) and higher costs (

Healthcare resource usage of schizophrenia patients initiating long-acting injectable antipsychotics vs oral

5,850 vs.

Healthcare Cost Reductions Associated with the Use of LAI Formulations of Antipsychotic Medications Versus Oral Among Patients with Schizophrenia

4,211; P = 0.0244); schizophrenia-related hospitalizations, LOS, and costs were also greater. Patients that were adherent used more schizophrenia-related medications (10.4 vs. 4.7; P < 0.0001), increasing pharmacy costs (

Prediction of cardiovascular risk in patients with familial hypercholesterolaemia

3,684 vs.

Administration costs of intravenous chemotherapy in treating peripheral T-cell lymphoma

1,549; P < 0.0001). Early nonadherence was correlated with lower drug adherence at each quarter of the follow-up period.ConclusionApproximately 60% of patients with schizophrenia are nonadherent to antipsychotic medication early in treatment and are less likely to be adherent later. Early nonadherence resulted in more all-cause and schizophrenia-related hospitalizations with a greater LOS and cost of care.

Cardiovascular Disease and its Risk Factors in Patients with Familial Hypercholesterolemia: A Systematic Review

Abstract Objective: To compare hospitalizations and incidence of relapses among patients with schizophrenia initiating long-acting injectable (LAI) antipsychotics vs oral antipsychotics. Methods: Patients with schizophrenia initiating LAI antipsychotics or oral antipsychotics (index events) were identified from large databases (MarketScan; Truven Health Analytics, CA), containing commercial and Medicare healthcare claims and their pre-index (12-month baseline period) and post-index (12-month follow-up period) hospitalizations and relapse rates were compared. Descriptive and bivariate statistics were utilized to compare demographics, clinical characteristics, and hospital resource usage among cohorts. Multivariate analysis was used to evaluate the impact of initiating LAI vs oral antipsychotics on differences in the number of hospitalizations and length of stay (LOS) between follow-up and baseline periods. Results: Commercially insured patients initiating LAI antipsychotics (n = 394) had significant reductions in inpatient healthcare usage after initiating antipsychotic therapy: mean number (±standard deviation) of all cause hospitalizations (1.60 ± 1.66 vs 0.70 ± 1.20, p < 0.001), LOS (16.9 ± 20.7 vs 6.6 ± 14.4 days, p < 0.001), schizophrenia-related hospitalizations (1.03 ± 1.26 vs 0.43 ± 0.86, p < 0.001), associated LOS (12.3 ± 17.7 vs 4.8 ± 12.8 days, p < 0.001). Patients initiating LAI vs oral antipsychotics (n = 2610) had significantly greater reductions during the follow-up period vs baseline period in the mean number of all cause hospitalizations (−0.90 ± 1.77 vs 0.02 ± 1.49, p < 0.001), LOS (−10.3 ± 23.2 vs 0.7 ± 16.7 days, p < 0.001), schizophrenia-related hospitalizations (−0.60 ± 1.37 vs 0.05 ± 0.99, p < 0.001) and associated LOS (−7.5 ± 20.7 vs 0.6 ± 12.5 days, p < 0.001). These results were further supported by multivariate analyses in which patient characteristics were taken into consideration. Limitations: This study attempted to minimize the impact of differences in patient characteristics by having patients serve as their own controls in the before vs after comparison followed by multivariate regressions, however one still may not be able to account for all confounders in this non-randomized study population. Conclusion: Patients with schizophrenia who initiated LAI vs oral antipsychotics experienced reductions in hospitalizations and schizophrenia relapses after drug initiation, which may be indicative of improved disease management.

Efficacy and Effectiveness of Depot Versus Oral Antipsychotics in Schizophrenia: Synthesizing Results Across Different Research Designs

Real-world medication adherence and healthcare costs of patients with schizophrenia initiating long-acting injectable (LAI) vs. oral antipsychotics were compared. Patients with schizophrenia initiating LAI or oral antipsychotics (index event) were identified from MarketScan Commercial and Medicare claims databases and their medication possession ratios (MPR), pre- and post-index costs for inpatient/outpatient care were compared. Of 3,004 patients, 394 initiated LAI antipsychotics and 2,610 oral antipsychotics. Post-index, the mean MPR was greater for the LAI cohort (0.67 ± 0.34 vs. 0.56 ± 0.35; p < 0.001). Schizophrenia-related hospital costs for LAI users were reduced during the follow-up period in comparison to the pre-index period, but were increased for patients using oral antipsychotics (-

Cardiovascular Disease Risk Associated With Familial Hypercholesterolemia: A Systematic Review of the Literature

5,981 ± 

Asthma in the elderly: the role of exhaled nitric oxide measurements.

16,554 vs. 758 ± 14,328, p < 0.001). The change in costs of outpatient care also favored LAI medications (

Analysis of Drug and Administrative Costs Allowed by U.S. Private and Public Third-Party Payers for 3 Intravenous Biologic Agents for Rheumatoid Arthritis

134 ± 8,280 vs. 658 ± 3,260, p = 0.023). Drug costs of LAI antipsychotics were higher (