Liisa Palmer

Dose trends for second-generation antipsychotic treatment of schizophrenia and bipolar disorder

BACKGROUND Antipsychotic dosing used in clinical practice can differ from dosing originally recommended in product labeling. This has been reported for olanzapine and quetiapine, where higher doses are commonly used. This may be the case for ziprasidone as well. METHOD To characterize changes over time in dosing for the initial and subsequent prescriptions of first-line second-generation antipsychotics used during treatment episodes for outpatients with schizophrenia and bipolar disorder, the 2001-2005 Thomson MarketScan Medicaid Database (Medicaid) and the 2001-2006 MarketScan Commercial Claims and Encounters Database (Commercial) were analyzed. Dose trends were evaluated using autoregressive time-series models. RESULTS Data were available for 49180 treatment episodes of schizophrenia (4683 Commercial and 44497 Medicaid) and 83289 treatment episodes of bipolar disorder (57961 Commercial and 25328 Medicaid). The initial prescription mean daily and overall mean daily doses of ziprasidone in schizophrenia episodes significantly increased across the Medicaid and Commercial populations, with similar trends observed for bipolar episodes. The first (May 2001) and last (December 2005) observed 3-month mean daily doses for ziprasidone were 112 mg/d and 138 mg/d for patients with schizophrenia and 93 mg/d and 113 mg/d for those with bipolar disorder in the Medicaid cohort, with similar findings for the Commercial cohort. Consistently significant trends in dose changes were not observed for the other medications, although quetiapine and olanzapine doses generally increased while aripiprazole and risperidone doses generally decreased. CONCLUSIONS There remains a need for controlled randomized clinical trials that test fixed doses of antipsychotics to ascertain the dose-response relationship within the dose range used in contemporary clinical practice.

Healthcare costs within a year of respiratory syncytial virus among Medicaid infants.

Limited research exists on the economic impact of respiratory syncytial virus lower respiratory infection (RSV LRI) among vulnerable infant populations. This study evaluated healthcare costs of full‐term and late‐preterm Medicaid infants with RSV LRI within 1 year of infection. Medicaid administrative claims were used to conduct a retrospective study of infants born 2003–2005. Full‐term and late‐preterm infants <1 year old were assigned to groups based on RSV LRI and unspecified bronchiolitis/pneumonia (UBP) diagnosis codes and stratified by setting of diagnosis. Infants without evidence of RSV LRI/UBP were selected as a comparison group. Economic and clinical outcomes were analyzed descriptively using propensity score weighting, and logged ordinary least squares models were used to examine relationship between RSV and costs incurred within 1 year of infection. RSV LRI and UBP infants, regardless of gestational age or healthcare setting, were more likely to experience respiratory diagnoses of wheezing and infantile asthma versus comparisons. Adjusted and weighted healthcare costs were significantly higher for all groups of RSV LRI and UBP infants relative to comparison infants (P < 0.001). Among late‐preterm infants with inpatient and outpatient RSV, marginal costs compared with controls were

Impact of real-world ziprasidone dosing on treatment discontinuation rates in patients with schizophrenia or bipolar disorder

17,465 and

Trends in dual-energy X-ray absorptiometry in the United States, 2000-2009.

2,158, respectively. Costs for RSV LRI and UBP Medicaid infants are substantial. While much of the costs result from initial RSV episodes, higher post‐episode costs and rates of respiratory events, procedures, and medications in RSV and UBP infants versus comparisons indicate long‐term economic impact from infection and the impact is greater among late‐preterm compared to full‐term infants. Pediatr. Pulmonol. 2010; 45:772–781.

Association of RSV lower respiratory tract infection and subsequent healthcare use and costs: a Medicaid claims analysis in early-preterm, late-preterm, and full-term infants.

BACKGROUND The purpose of this study is to evaluate the relationship between maximum dose of ziprasidone and time to discontinuation in the treatment of schizophrenia/schizoaffective disorder and bipolar disorder in clinical practice. METHOD The 2001-2006 MarketScan Commercial and Medicare Databases were analyzed for maximum ziprasidone doses achieved in patients with schizophrenia/schizoaffective disorder or bipolar disorder. Ziprasidone maximum-dose groups were defined as low (20-60 mg/d), medium (61-119 mg/d), or high (120-160 mg/d). Patients receiving >160 mg/d were excluded. Mean time to discontinuation was evaluated across propensity score-matched dosing groups. Cox proportional hazard models were used to adjust for confounding when comparing the high- and medium-dose groups with the low-dose group. RESULTS Data were available for 33,340 patients with schizophrenia/schizoaffective disorder, of whom 16.6% received low dose of ziprasidone, 22.0% medium dose, and 61.4% high dose. Of those subjects with bipolar disorder (n=27,751), 26.1% were receiving a low dose of ziprasidone, 25.7% a medium dose, and 48.3% a high dose. Among the propensity score-matched dosing groups, the respective mean time to discontinuation for low, medium, and high doses was 90.5, 117.2, and 201.6d within the schizophrenia/schizoaffective disorder cohort and 84.6, 110.7, and 173.2d within the bipolar cohort (p<0.0001 for all comparisons). The hazard ratios for discontinuing therapy were significantly lower for the medium- (0.84, 0.84) and high-dose (0.57, 0.60) groups relative to the low-dose group in schizophrenia/schizoaffective disorder and bipolar disorder, respectively. CONCLUSIONS Patients with schizophrenia/schizoaffective or bipolar disorders receiving ziprasidone 120-160 mg/d experienced a statistically significant lower discontinuation rate compared with those receiving lower doses.

Respiratory outcomes, utilization and costs 12 months following a respiratory syncytial virus diagnosis among commercially insured late-preterm infants.

After a decade of policies encouraging dual-energy X-ray absorptiometry (DXA) use, Medicare incrementally decreased reimbursement for non-facility-based DXAs, effective 2007. This study quantifies trends in central DXA use before and after the reimbursement change. Using 2000-2009 claims data, we selected subjects aged 50+yr with Medicare supplemental or commercial insurance. The central site DXA test (using CPT codes) rate was calculated within each calendar quarter as the number of patients with a DXA test divided by the total number of patients. Piecewise linear regression was used to quantify change in DXA rates coincident with the 2007 reimbursement reductions. During 2000-2009, slightly over 5 million DXA tests were conducted. Annual rates for females with Medicare steadily increased until 2007, when they leveled off; a similar pattern was observed for the commercially insured. Regression modeling showed that pre-2007 rates increased annually by 0.76% (0.72-0.80) and 0.76% (0.70-0.82) among those with Medicare supplemental and commercial insurance, respectively, and over 2007-2009, rates changed annually by +0.07% (-0.05% to 0.19%) and -0.12% (-0.29% to 0.04%), respectively. During 2007-2009, there were 3.1 (2.4-3.8) and 4.0 (3.1-4.9) fewer tests per 100 person years for females with Medicare supplemental and commercial insurance, respectively, than would have been expected based on the pre-2007 trend. The post-2007 DXA rate was lower than what would have been expected had the observed trend of increasing annual DXA rates from 2000 to 2007 continued unabated beyond the Medicare reimbursement change in 2007. Continuing to provide access to DXA testing for women at increased risk of osteoporosis is important to providing high-quality care for metabolic bone disease in the United States.

Patterns of atypical antipsychotic therapy use in adults with bipolar I disorder in the USA.

Abstract Objective: Healthcare use and costs within 1 year of a respiratory syncytial virus lower respiratory tract infection (RSV-LRI) among Medicaid early-preterm and late-preterm infants compared with full-term infants were evaluated. Methods: Infants born during 2003–2005 were identified from the Thomson Reuters MarketScan Multi-State Medicaid Database. Infants <1 year of age were grouped based on RSV-LRI and unspecified bronchiolitis/pneumonia (UBP) diagnosis codes and stratified by inpatient or outpatient setting. Infants without RSV-LRI/UBP were selected for comparison. Economic and clinical outcomes were analyzed descriptively; the relationship between RSV-LRI/UBP and costs incurred within 1 year of infection were analyzed using logged ordinary least squares models. Results were stratified by gestational age. Results: Most infants were diagnosed with RSV-LRI/UBP after 90 days of chronologic age. Early-preterm infants had the greatest mean number of inpatient, outpatient, and emergency department visits after an RSV-LRI/UBP episode. The marginal costs among infants with RSV-LRI compared with controls were

Herpes Zoster-Attributable Resource Utilization and Cost Burden in Patients With Solid Organ Transplant

34,132 (p < 0.001) and

PIN32 THE CHILD AND HOUSEHOLD INFLUENZA-ILLNESS AND EMPLOYEE FUNCTION (CHIEF) STUDY-LINKING SURVEY AND CLAIMS DATA TO UNDERSTAND DISEASE IMPACT ON INDIRECT COSTS

3869 (p = 0.115) among inpatients and outpatients, respectively. Among late-preterm infants, the marginal costs were

Effect of influenza-like illness and other wintertime respiratory illnesses on worker productivity: the child and household influenza-illness and employee function (CHIEF) study.

17,465 (p < 0.001) and