Lawrence J. Cohen

The association between class of antipsychotic and rates of hospitalization: Results of a retrospective analysis of data from the 2005 medicare current beneficiary survey

BACKGROUND When second-generation antipsychotics (SGAs), also called atypical antipsychotics, were introduced in the 1990s, early research suggested that these drugs offered better tolerability and adherence than first-generation antipsychotics (FGAs), or typical antipsychotics. This presumably would reduce the need for hospital services. However, health research to test this hypothesis has focused mostly on psychiatric readmissions. OBJECTIVE The objective of this study was to compare rates of all-cause hospitalization among patients receiving different classes of antipsychotics (SGAs, FGAs, both, or neither) in a large, all-ages sample of both institutionalized and noninstitutionalized Medicare beneficiaries. METHODS We examined the 2005 Medicare Current Beneficiary Survey Cost and Use file for 11,236 survey participants. Antipsychotic utilization was characterized in terms of class: FGA (ie, chlorpromazine, fluphenazine, haloperidol, loxapine, perphenazine, thiothixene, thioridazine, or trifluoperazine) or SGA (ie, aripiprazole, clozapine, olanzapine, quetiapine, risperidone, or ziprasidone). Hospitalization was defined in terms of whether a Medicare beneficiary was admitted to the hospital for any reason in 2005, and was measured in terms of the number of hospital visits. In our final model, we included the following confounding variables: disability status (> or =1 limitation in activities of daily living), Rosow-Breslau impairment score (difficulty with walking, stooping, crouching, kneeling, or doing heavy housework), cognitive impairment (diagnosis of Alzheimers disease or memory loss that interfered with daily activity), and health behavior variables (body mass index and smoking status). RESULTS A total of 3.5% of Medicare beneficiaries (1.3 million) filled > or =1 prescription for an antipsychotic medication in 2005. Controlling for demographic, socioeconomic, health, and disability variables, SGA-only users were more than twice as likely (odds ratio [OR] = 2.2 [95% CI, 1.7-2.9]) and combination users were more than 6 times as likely (OR = 6.3 [95% CI, 2.4-16.2]) as nonusers to be hospitalized. The odds of FGA users being hospitalized were not significantly different from nonusers (OR = 1.4 [95% CI, 0.7-2.8]). CONCLUSIONS This analysis yielded provocative, but by no means conclusive, evidence that SGAs as a class are not necessarily superior to FGAs in mitigating patients use of hospital services under real-world conditions. Systematic analysis of this relationship with a large, multiple-year sample of Medicare beneficiaries is warranted.

Estimating the potential savings with vagus nerve stimulation for treatment-resistant depression: a payer perspective

ABSTRACT Objective: To provide a formula estimating potential reductions in healthcare utilization costs with adjunctive vagus nerve stimulation (VNS Therapy†) in treatment-resistant depression (TRD). † VNS Therapy is a trademark of Cyberonics, Inc., Houston, TX, USA Methods: This payer-perspective formula incorporates costs of treatment as usual for TRD patients from a published analysis of the MarketScan private payer claims database and the 2004 Medicare 5% standard analytic file. Estimated remission and response rates are from the published VNS pilot and pivotal studies. Costs were converted to 2008 US dollars per the US Bureau of Labor Statistics medical care costs, consumer price index. Device and implantation costs were calculated at

Issues in Adherence to Treatment With Monoamine Oxidase Inhibitors and the Rate of Treatment Failure

28 336. Results: From the MarketScan and pooled outcomes data (VNS pilot and pivotal studies), potential per patient savings (hospitalization directly and indirectly related to depression) was

Introduction: a fresh look at monoamine oxidase inhibitors for depression.

2974 at 5 years of device life,

Discussion: A Fresh Look at Monoamine Oxidase Inhibitors for Depression

23 539 at 8 years (moderate cost reduction scenario);

Coverage of atypical antipsychotics among medicare drug plans in the state of washington: changes between 2007 and 2008.

12 914 at 5 years,

Selegiline Transdermal System: Use Pattern and Adherence in Patients With Major Depressive Disorder

40 935 at 8 years (optimistic scenario). Corresponding break-even device life was 4.57 and 3.62 years, respectively. From the Medicare file and pooled outcomes, potential per patient savings (inpatient and outpatient directly and indirectly related to depression) was

MAOIs: issues in treatment adherence and rates of treatment failure.

8358 at 5 years of device life,

Coverage of Atypical Antipsychotics Among Medicare Drug Plans in the State of Washington for Fiscal Year 2007

32 385 at 8 years (moderate scenario);

Selegiline Transdermal System (STS) for Major Depressive Disorder (MDD): Use Pattern, Adherence, and Effect on Health Service Expenditures

19 837 at 5 years,