Lesley-Ann Miller

Comparing Adherence to and Persistence with Antipsychotic Therapy Among Patients with Bipolar Disorder

Background: Medication nonadherence is a significant problem among patients with bipolar disorder. Objective: To compare adherence and persistence among patients with bipolar disorder initiated on antipsychotics in a state Medicaid system over a 12 month follow-up period. Methods: Claims data for patients with bipolar disorder from a de-identified Medicaid database were examined. Patients were classified into 4 monotherapy treatment groups (risperidone, olanzapine, quetiapine, or typical antipsychotic) based on the first prescription filled between January 1, 1999, and December 31, 2001. Adherence and persistence were analyzed over a 12 month follow-up period. Adherence was measured using the Medication Possession Ratio (MPR). Persistence was defined as the total number of days from the initiation of treatment to therapy modification (ie, discontinuation, switching, or combination with another antipsychotic). Adjustment for confounding variables was undertaken using ordinary least-squares and Cox proportional hazard regression modeling. Results: The mean MPRs were 0.68 for risperidone (n = 231), 0.68 for olanzapine (n = 283), 0.71 for quetiapine (n = 106), and 0.46 for typical antipsychotics (n = 205). Patients initiated on typical antipsychotics were 23.6% less adherent than patients initiated on risperidone (p < 0.001). Mean persistence (days) was 194.8 for risperidone, 200.9 for olanzapine, 219.8 for quetiapine, and 179.2 for typical antipsychotics. Extended Cox regression modeling indicated no significant differences between antipsychotics in hazards of therapy modification within 250 days of initiation. However, patients initiated on typical antipsychotics were 5.2 times more likely to modify therapy compared with those initiated on risperidone after 250 days of antipsychotic therapy (p < 0.001). Conclusions: Adherence and persistence were similar between atypical antipsychotic groups. The typical antipsychotic group, however, demonstrated lower adherence and a greater likelihood of patients modifying therapy compared with the risperidone cohort

Economic evaluation of four angiotensin II receptor blockers in the treatment of hypertension.

Abstract Objective: To evaluate the cost effectiveness of achieving JNC 7 blood pressure goals with angiotensin II receptor blockers (ARBs). Research design and methods: Cost effectiveness of olmesartan, losartan, valsartan, and irbesartan was compared with real world patient chart and claims data from a large US health plan. Patients 18 and older with ≥2 claims for an ARB between May 1, 2002 and December 31, 2005 were identified from the claims database. Patients with a diagnosis of hypertension in the 6-month baseline period before the first (index) ARB claim and ARB-free during baseline were included. Medical charts were randomly sampled from the cohort of identified patients; effectiveness data were obtained from charts and linked to healthcare claims and costs. These data were used to populate the decision analytic model. Main outcome measures: All-cause and hypertension-attributable costs to achieve JNC 7 goals were measured. Comparisons were made within low and high-dose strata and pooled across ARB doses. Results: 121 472 patients were identified, and charts were randomly abstracted for 1600. Of these, 1293 patients were hypertensive at index. Baseline patient characteristics for the chart group were modestly different from the larger cohort. More patients treated with olmesartan (77.8%) than with losartan (66.5%), valasartan (68.8%), or irbesartan (68.8%) achieved JNC 7 BP goals. In pooled-dose comparisons, cost per patient reaching BP goal was

Rasch analysis informed the development of a classification system for a diabetes-specific preference-based measure of health

8964 (all-cause) and

Estimation of a Valuation Function for a Diabetes Mellitus-Specific Preference-Based Measure of Health: The Diabetes Utility Index

2704 (hypertension-attributable) for olmesartan; compared with

Patterns of cervical cancer screening, diagnosis, and follow-up treatment in a state Medicaid fee-for-service population.

10 848 and

Impact of Visual Impairment on Health-Related Quality of Life in Multiple Sclerosis

3291 for losartan;

Patterns of Care in Patients with Metastatic Renal Cell Carcinoma Among a U.S. Payer Population with Commercial or Medicare Advantage Membership

10 557 and

Comparative economic analysis of aromatase inhibitors and tamoxifen in the treatment of hormone-dependent breast cancer

3577 for valsartan; and

Comment: pharmacist intervention enhances adherence to orlistat therapy:

13395 and

Persistence, Adherence, and Switch Rates Among Extended-Release and Immediate-Release Overactive Bladder Medications in a Regional Managed Care Plan

4325 for irbesartan, respectively. The trend was similar for the dose stratification analysis, except in the comparison between high-dose losartan and olmesartan, where losartan had a lower cost-effectiveness ratio. Conclusion: Overall olmesartan was the most effective and cost-saving treatment option compared to losartan, valsartan, and irbesartan for the achievement of JNC 7 BP goals in this managed-care population.