Bryan M. Johnstone

Olanzapine versus Risperidone: A Prospective Comparison of Clinical and Economic Outcomes in Schizophrenia

AbstractObjective: To compare the clinical and economic outcomes associatedwith olanzapine and risperidone treatment for schizophrenia. Design and setting: An international, multicentre, double-blind, prospective study. To facilitate economic comparisons, our sample was restricted to patients enrolled in US sites. 150 patients with a Diagnostic and Statistical Manual of mental disorders, 4th edition (DSM-IV) diagnosis of schizophrenia, schizoaffective disorder or schizophreniform disorder were randomised to therapy with either olanzapine 10 to 20 mg/day (n = 75) or risperidone 4 to 12 mg/day (n = 75) for a maximum of 28 weeks. In addition to tolerability and efficacy assessments, use of health services was assessed at baseline and prospectively, at 8-week intervals and at study completion. Clinically important response, defined as a 40% improvement in the Positive and Negative Syndrome Scale total score, maintenance of response and rates of treatment-emergent extrapyramidal symptoms were compared between groups. Direct medical costs were estimated by assigning standardised prices to resource units. Median total, inpatient/outpatient service and medication acquisition costs were compared between treatment groups. Main outcome measures and results: The mean modal dosages for the olanzapine and risperidone treatment groups were 17.7 ± 3.4 mg/day and 7.9 ± 3.2 mg/day, respectively. Olanzapine-treated patients were more likely to maintain response compared with risperidone-treated patients (p = 0.048). In addition, a smaller proportion of olanzapine-treated patients required anticholinergic therapy compared with risperidone-treated patients (25.3 vs 45.3%; p = 0.016). Total per patient medical costs over the study interval were

Evaluation of antipsychotic and concomitant medication use patterns in patients with schizophrenia.

US2843 (1997 values) [36%] lower in the olanzapine treatment group than in the risperidone treatment group (p = 0.342).Medication costs were significantly higher for olanzapine-treated patients (

Mixed-Model Imputation of Cost Data for Early Discontinuers from a Randomized Clinical Trial

US2513 vs

Dosing Patterns for Duloxetine and Predictors of High-Dose Prescriptions in Patients With Major Depressive Disorder: Analysis from a United States Third-Party Payer Perspective

US1581; p < 0.001), but this difference was offset by a reduction of

PMH14 ADHERENCE AND PERSISTENCE WITH DULOXETINE VERSUS ESCITALOPRAM AMONG HIGH HEALTH-CARE RESOURCES UTILIZERS WITH MAJOR DEPRESSIVE DISORDER

US3774 (52%) in inpatient/outpatient service costs for olanzapine-treated patients in comparison with risperidone-treated patients (

PMH19: ANTIPSYCHOTIC DRUG USE PATTERNS AND THE COST OF TREATING SCHIZOPHRENIA: DATA FROM THE MEDICAID PROGRAMS OF ALABAMA, GEORGIA, KENTUCKY, AND MICHIGAN

US3516 vs

Real-world practice patterns, health-care utilization, and costs in patients with low back pain: the long road to guideline-concordant care

US7291, p = 0.083).Median cost findings were consistent with results observed using other robust measures of central tendency and provide conservative estimates of potential savings that may be obtained from olanzapine therapy. Conclusions: In this study, olanzapine-treated patients experienced clinical improvements that translated into savings in costs of care for both inpatient and outpatient services. These savings offset the difference in medication acquisition cost between olanzapine and risperidone.

Reliability, validity, and application of the medical outcomes study 36-item short-form health survey (SF-36) in schizophrenic patients treated with olanzapine versus haloperidol.

OBJECTIVE To describe antipsychotic medication use patterns in an inner-city, outpatient population of indigent patients with schizophrenia. METHODS This retrospective cohort study used the Regenstrief Medical Record System to identify schizophrenic patients receiving antipsychotic medication(s). Patients were included and identified as initiating a new treatment episode if they did not receive any antipsychotic prescription for 90 days before their first antipsychotic prescription in 1995. Each patient was followed for 1 year. RESULTS Three hundred and sixteen patients met study criteria. Typical and atypical (clozapine and risperidone) antipsychotic agents were selected as initial therapy in 88% and 12% patients, respectively. The majority of patients (71.5%) were exposed to only one antipsychotic agent during their treatment year. Approximately 25% of all patients switched from one antipsychotic to a different antipsychotic during 12 months of therapy. Nearly 90% of patients augmented their prescribed antipsychotic with a concomitant medication during the 12-month study period. Approximately 30% of the cohort received treatment with an antipsychotic for 12 continuous months and were, thus, classified as having stable antipsychotic therapy. The majority of patients (67.1%) had periods of interrupted therapy (range, 1-11 months) during the 12 month study period. CONCLUSION As of 1995 an overwhelming majority of schizophrenic patients in this indigent, inner-city population initiated therapy with a typical antipsychotic. Patients frequently switched antipsychotics and discontinued their therapy during the 1 year study period. Reasons for switching or discontinuing may include the following: ineffective therapy; patient intolerance; change in symptoms; and improved assessment and understanding of the diagnosis or physician preference.

Antipsychotic Drug Use Patterns and the Cost of Treating Schizophrenia

For studies with appreciable attrition in which one expects not only differences between individual patients but also time trends in repeated measures, a “sophisticatedly simple” approach to imputation of missing values is illustrated. A linear model having random patient intercept and slope terms as well as fixed effects for treatment, investigator, time, and interactions between both treatment-investigator and treatment-time is used. In contrast to a purely fixed effects approach, mixed-model estimation then optimally shrinks patient-specific differences toward zero. This shrinkage moves the predictions for each patient toward the average time line for the corresponding investigator and treatment. Using a variety of sensitivity analyses, it is established that imputation of missing values using these mixed-model predictions provides a “benchmark” lower limit for cost differences between treatments. To illustrate concepts, supplementary analyses of selected cost and effectiveness outcomes from a randomized, double-blind trial of olanzapine versus haloperidol for the treatment of schizophrenia are presented.

Designing Naturalistic Prospective Studies of Economic and Effectiveness Outcomes Associated with Novel Antipsychotic Therapies

BACKGROUND Major depressive disorder (MDD) is a common illness that affects ∼7% of adults in the United States each year. Duloxetine is a dual reuptake inhibitor of serotonin and norepinephrine that has demonstrated efficacy and tolerability in the treatment of MDD. OBJECTIVE The purpose of our study was to examine dosing patterns and pretreatment predictors of high-dose duloxetine therapy for patients with MDD in the usual clinical setting. METHODS Data were from 6132 commercially insured patients with MDD initiated on duloxetine during 2005 and 2006. Patients had no duloxetine use in the previous 6 months and had continuous enrollment in a health plan for the 12 months immediately preceding and following initiation. Dosing patterns and predictors of high-dose therapy with duloxetine were examined. RESULTS Initial doses of duloxetine were <60 mg/d, 60 mg/d, 90 mg/d, and ≥120 mg/d for 32.4%, 60.9%, 3.1%, and 3.5% of patients, respectively. Maximum daily doses were <60 mg, 60 mg, 90 mg, and ≥120 mg for 16.3%, 59.3%, 11.0%, and 13.3% of patients, respectively. Patients treated with >60 mg/d for at least 2 months were older, were more likely to have been treated by a psychiatrist, had greater comorbidity, and had used more health care resources and psychotropic and pain medications in the previous year. The following factors were independently associated with doses of >60 mg/d: older age (odds ratio [OR] = 1.33-1.46); comorbid neuropathic pain (OR = 1.88); fibromyalgia (OR = 1.36); dysthymic disorder (OR = 1.24); prior injury/poisoning (OR = 1.19); physician specialty (psychiatrist, OR = 1.55); and prior use of psychostimulants (OR = 1.26), benzodiazepines (OR = 1.19), venlafaxine (OR = 1.35), or atypical antipsychotics (OR = 1.35). CONCLUSIONS Most of the commercially insured patients in this dataset were initiated and maintained on a duloxetine dose of 60 mg/d. Although the data are limited in their generalizability, the characteristics associated with higher dose therapy describe a complex group of patients who may require more intensive drug treatment and monitoring.