Krithika Rajagopalan

Treatment adherence among patients with schizophrenia treated with atypical and typical antipsychotics

This study evaluated treatment adherence among patients with schizophrenia receiving atypical and typical antipsychotics. Claims data for 7017 treatment episodes of commercially insured patients with schizophrenia (ICD-9-CM) receiving antipsychotics, covering the period from January 1999 through August 2003, were assessed. Overall adherence was evaluated by adherence intensity (medication possession ratio) and treatment duration (length of treatment episode). Pair-wise comparisons of the individual atypicals and a combined group of leading typical antipsychotics were undertaken using multiple regression, adjusting for differing patient characteristics. Each atypical antipsychotic demonstrated a significantly higher adherence intensity than the combined typicals, while quetiapine demonstrated a significantly greater adherence intensity than risperidone and olanzapine. None of the atypicals showed treatment durations significantly different from the typicals. While the small improvements in adherence intensity among atypical agents do not appear to be clinically important, they may reflect an underlying, stronger tendency to use filled prescriptions.

Antipsychotic treatment adherence and associated mental health care use among individuals with bipolar disorder

BACKGROUND Up to 48% of patients with bipolar disorder are either nonadherent or partially adherent to antipsychotic drug treatment. Medication adherence may differ by bipolar disorder subtype. OBJECTIVE This study evaluated the association between antipsychotic treatment adherence and mental health care use among individuals with bipolar disorder with predominantly manic/mixed symptoms or predominantly depressive symptoms. METHODS Individuals with bipolar or manic disorder who had at least 1 medical claim with International Classification of Diseases, Ninth Revision, Clinical Modification codes 296.4-296.8 (bipolar disorder) or 296.0 or 296.1 (manic disorder) were identified from medical and pharmacy claims in the PharMetrics database for the period from January 1999 through December 2004. Adherence was measured by intensity (medication possession ratio [MPR]) and treatment duration. The association between adherence and health care use during and after antipsychotic treatment was evaluated using multiple regression analysis. The traditional P < 0.05 threshold was used for statistical significance; however, results that approached significance at P < 0.10 were also noted. RESULTS Claims data were examined for 13,941 antipsychotic treatment episodes occurring in 12,952 individuals with bipolar or manic disorder. Of these, 6153 treatment episodes occurred in 5711 individuals with predominantly manic/mixed symptoms, and 2617 occurred in 2381 individuals with predominantly depressive symptoms. The remaining 5171 treatment episodes occurred in 4860 individuals with unspecified bipolar disorder and were not included in the analysis. In individuals with manic/mixed symptoms, a higher MPR was associated with reduced total and outpatient mental health expenditures over subsequent stages of treatment (reduction in total expenditure per 1-point increment in MPR:

Lost time, absence costs, and reduced productivity output for employees with bipolar disorder.

123-

Hospital readmissions following initiation of nebulized arformoterol tartrate or nebulized short-acting beta-agonists among inpatients treated for COPD

439; P < 0.001). In individuals with predominantly depressive symptoms, the association between MPR and subsequent mental health expenditure reached statistical significance only in months 10-12, the 3rd of the 4 treatment segments examined (total mental health expenditure: -

Costs of physical and mental comorbidities among employees: a comparison of those with and without bipolar disorder.

714 [P < 0.001]; outpatient mental health expenditure: -

Budgetary impact of treating acute bipolar mania in hospitalized patients with quetiapine: an economic analysis of clinical trials.

468 [P < 0.001]). A higher MPR was also associated with a lower likelihood of acute mental health care (inpatient hospitalization or an emergency department visit) in subsequent months in individuals with manic/mixed symptoms or depressive symptoms (odds ratio = 0.545 [95% CI, 0.30- 1.00] and 0.395 [95% CI, 0.14-1.12], respectively; both NS at the P < 0.05 threshold), and was not associated with mental health inpatient days. In both subgroups, a longer duration of treatment was associated with lower total and outpatient mental health expenditures during the 4 months after the termination of treatment (both, P < 0.01). CONCLUSIONS In these individuals with bipolar or manic disorder, improved adherence to antipsychotic treatment was associated with lower subsequent total and outpatient mental health care expenditures. This association was less pronounced in individuals with predominantly depressive symptoms than in those with predominantly manic/mixed symptoms.

Hospitalization risks in the treatment of schizophrenia: comparison of antipsychotic medications.

Objective:We sought to evaluate the incremental health-related lost work time and at-work productivity loss for employees with bipolar disorder (BPD). Methods:Health-related absence and real productivity output of employees with BPD were compared with that of non-BPD and other employee cohorts from a large employer database using multivariate regression to control for cohort differences. Results:After adjusting for confounding factors, employees with BPD had significantly higher absence costs (

Hospitalisation risks in the treatment of schizophrenia in a Medicaid population: comparison of antipsychotic medications.

1219) and 11.5 additional lost days (P < 0.05) per year than those without BPD. Adjusted annual productivity output was 20% lower for the BPD group (P < 0.05). Conclusions:Employees with BPD are less likely to be present for work. When present, their productivity level is similar to that of other employees, but over the course of a year, their absence rates result in significant productivity losses.

Long-term cost-effectiveness of atypical antipsychotics in the treatment of adults with schizophrenia in the US

Background Inpatient admissions for chronic obstructive pulmonary disease (COPD) represent a significant economic burden, accounting for over half of direct medical costs. Reducing 30-day readmissions could save health care resources while improving patient care. Recently, the Patient Protection and Affordable Care Act authorized reduced Medicare payments to hospitals with excess readmissions for acute myocardial infarction, heart failure, and pneumonia. Starting in October 2014, hospitals will also be penalized for excess COPD readmissions. This retrospective database study investigated whether use of arformoterol, a nebulized long-acting beta agonist, during an inpatient admission, had different 30-day all-cause readmission rates compared with treatment using nebulized short-acting beta agonists (SABAs, albuterol, or levalbuterol). Methods A US nationally representative hospital database was used to study adults aged ≥40 years, discharged between January, 2006 and March, 2010, and with a diagnosis of COPD. Patients receiving arformoterol on ≥80% of days following treatment initiation were compared with patients receiving a nebulized SABA during hospitalization. Arformoterol and nebulized SABA patients were matched (1:2) for age, sex, severity of inpatient admission, and primary/secondary COPD diagnosis. Logistic regression compared the odds of readmission while adjusting for age, sex, race, admission type, severity, primary/secondary diagnosis, other respiratory medication use, respiratory therapy use, oxygen use, hospital size, and teaching status. Results This retrospective study compared 812 arformoterol patients and 1,651 nebulized SABA patients who were discharged from their initial COPD hospital admission. An intensive care unit stay was more common among arformoterol patients (32.1% versus 18.4%, P<0.001), suggesting more severe symptoms during the initial admission. The observed readmission rate was significantly lower for arformoterol patients than for nebulized SABA patients (8.7% versus 11.9%, P=0.017), as were the adjusted odds of readmission (odds ratio 0.69, 95% confidence interval 0.51–0.92). Conclusion All-cause 30-day readmission rates were significantly lower for arformoterol patients than nebulized SABA patients, both before and after adjusting for patient and hospital characteristics.

Cost-effectiveness of lurasidone vs aripiprazole among patients with schizophrenia who have previously failed on an atypical antipsychotic: an indirect comparison of outcomes from clinical trial data

ABSTRACT Objective: To compare the cost and utilization of health care services for various comorbid conditions among employees with bipolar disorder (BPD) and two other population cohorts: employees without BPD and employees with other mental disorders (OMD). Methods: Retrospective database analysis on a 2‐year study period, from January 1, 2001, through December 31, 2002 using adjudicated health insurance medical claims on more than 230 000 employees plus their eligible dependents. Study comparisons were performed among employees with BPD (cohort BPD), employees without BPD (cohort NBD), and employees with OMD (cohort OMD). Outcome measures included the cost and utilization of health services for various comorbid conditions as defined by the Agency for Healthcare Research and Quality (AHRQ); using 261 specific categories (SCs) and the 17 Major Diagnostic Categories (MDCs). Results: Employees in cohort BPD ( n = 761) had greater average annual medical and prescription drug costs than the two other employee cohorts. Costs for cohort BPD were significantly greater ( p ≤ 0.05) than for cohort NBD ( n = 229 145) for six of the 17 MDCs, including the categories of mental disorders (