Mallik Greene

Medication adherence and discontinuation of long-acting injectable versus oral antipsychotics in patients with schizophrenia or bipolar disorder

Abstract Aims: To examine medication adherence and discontinuation in two separate groups of patients with schizophrenia or bipolar disorder (BD), who began receiving a long-acting injectable antipsychotic (LAI) versus those who changed to a different oral antipsychotic monotherapy. Materials and methods: The Truven Health Analytics MarketScan Multi-State Medicaid claims database was used to identify patients with schizophrenia; Truven Health Analytics MarketScan Commercial and Medicaid claims databases were used to identify patients with BD. The analyses included adult patients (≥18 years) who either began receiving an LAI (no prior LAI therapy) or changed to a different oral antipsychotic (monotherapy). The first day of initiating an LAI or changing to a new oral antipsychotic was the index date. Linear and Cox regression models were conducted to estimate medication adherence (proportion of days covered [PDC]) and time to medication discontinuation (continuous medication gap ≥60 days), respectively. Models adjusted for patient demographic and clinical characteristics, baseline medication use, and baseline ED or hospitalizations. Results: Patients with schizophrenia (N = 5638) who began receiving LAIs had better medication adherence (5% higher adjusted mean adherence) during the 1 year post-index period and were 20% less likely to discontinue their medication during the entire follow-up period than patients who changed to a different oral antipsychotic monotherapy, adjusting for differences between LAI users and oral users. Similarly, patients with BD (N = 11,344) who began receiving LAIs also had 5% better medication adherence and were 19% less likely to discontinue their medication than those using oral antipsychotics. Limitations: Clinical differences unmeasurable in this database may have been responsible for the choice of LAI versus oral antipsychotics, and these differences may be responsible for some of the adherence advantages observed. Conclusions: This real-world study suggests that patients with schizophrenia or BD who began receiving LAIs had better medication adherence and lower discontinuation risk than those who changed to a different oral antipsychotic monotherapy.

The economic burden of bipolar I disorder in the United States in 2015

BACKGROUND The current societal costs of bipolar I disorder (BDI) have not been comprehensively characterized in the United States, as previous studies are based on data from two decades ago. METHODS The costs of BDI were estimated for 2015 and comprised direct healthcare costs, non-healthcare costs, and indirect costs, calculated based on a BDI prevalence of 1%. The excess costs of BDI were estimated as the difference between the costs incurred by individuals with BDI and those incurred by individuals without BD or individuals from the general population. Direct healthcare costs were assessed using three large US claims databases for insured individuals and the literature for uninsured individuals. Direct non-healthcare and indirect costs were based on the literature and governmental publications. RESULTS The total costs of BDI were estimated at

All-cause hospitalization and associated costs in patients with schizophrenia or bipolar disorder initiating long-acting injectable antipsychotics

202.1 billion in 2015, corresponding to an average of

O8.5. SCHIZOPHRENIA AND BIPOLAR DISORDER DIAGNOSIS PATTERNS: REAL-WORLD EVIDENCE FROM US CLAIMS DATABASES

81,559 per individual, while the excess costs of BDI were estimated at

F75. MEDICATION ADHERENCE AND DISCONTINUATION IN PATIENTS WITH SCHIZOPHRENIA TREATED WITH ARIPIPRAZOLE ONCE-MONTHLY LONG-ACTING INJECTABLE VERSUS THOSE TREATED WITH ORAL ANTIPSYCHOTICS

119.8 billion, corresponding to an average of

Systematic literature review on patterns of pharmacological treatment and adherence among patients with bipolar disorder type I in the USA

48,333 per individual. The largest contributors to excess costs were caregiving (36%), direct healthcare costs (21%), and unemployment (20%). In sensitivity analyses, excess costs ranged from

Changes in healthcare resource use and costs associated with early versus delayed initiation of atypical antipsychotic adjunctive treatment in major depressive disorder

101.2 to

A real-world analysis of healthcare costs and relative risk of hyperprolactinemia associated with antipsychotic treatments in the United States

124.3 billion. LIMITATIONS Direct healthcare costs were calculated based on a BDI diagnosis, thus excluding undiagnosed patients. Direct non-healthcare and indirect costs were based on combined estimates from the literature. CONCLUSIONS Besides direct healthcare costs, BDI was associated with substantial direct non-healthcare and indirect costs. More effective treatments and practices are needed to optimize therapeutic strategies and contain direct and indirect costs.

Budget impact analysis of long-acting injectable aripiprazole once-monthly 400 mg in bipolar I disorder in the USA

Abstract Objective: To compare all-cause hospitalization and associated costs among patients with schizophrenia or bipolar disorder (BD) treated with long-acting injectable antipsychotics (LAIs). Methods: The Truven MarketScan Medicaid claims database was used to identify patients with schizophrenia; MarketScan Medicaid and commercial claims databases were used to identify BD. Adult patients with ≥1 LAI claim from January 1, 2013–June 30, 2014 (ID period) were identified. The first day of LAI initiation was the index date; patients were followed for ≥1 year. Logistic and general linear regression models were used to estimate the risk of hospitalization and associated costs. Results: Adjusted analyses showed that, in the schizophrenia cohort, risks of hospitalization were statistically significantly higher in the haloperidol [OR (95% CI) = 1.51 (1.05–2.16); HR (95% CI) = 1.35 (1.05–1.73)] and risperidone [OR (95% CI) = 1.58 (1.07–2.33); HR (95% CI) = 1.33 (1.01–1.74)] cohorts than in the aripiprazole once monthly extended release (AOM 400) cohort. Similarly, in patients with BD, risks of hospitalization were significantly higher in haloperidol [OR (95% CI) = 1.49 (1.01–2.19); HR (95% CI) = 1.33 (1.03–1.73)] and risperidone [OR (95% CI) = 1.78 (1.19–2.66); HR (95% CI) = 1.33 (1.01–1.75)] than in AOM400. No statistically significant differences in hospitalization costs were observed in either disease group. Conclusions: Although the study results may be subject to confounding variables that are not contained in claims databases, such as disease severity, it appears that AOM400 may be more effective than haloperidol and risperidone LAIs among patients with schizophrenia or BD.

Impact of initiating long-acting injectable antipsychotics on hospitalization in patients with bipolar I disorder

Abstract Background Schizophrenia and bipolar disorder (BD) are typically understood as separate and non-concurrent psychiatric disorders both in the clinical setting and in the DSM-V and ICD-10 classification systems. However, patients may experience both mood and schizophrenia symptoms simultaneously. Several studies have shown overlap between schizophrenia and BD symptoms, which may lead to diagnostic confusion. Additionally, molecular studies have confirmed that schizophrenia and BD share susceptibility genes. This study explored diagnosis patterns of patients with schizophrenia and/or type I bipolar disorder (BD-I) diagnoses in a real-world setting. Methods This was a retrospective cohort study using Truven MarketScan® Commercial, Medicaid, and Medicare Supplemental databases from the study period 01/01/2012 and 06/30/2016. Patients were considered to have a diagnosis of schizophrenia if 1 inpatient claim or 2 outpatient claims for schizophrenia were identified within a selected identification period (01/01/2013 and 06/30/2015). BD-I was defined in an analogous way, and the following five mutually exclusive cohorts were defined: 1) schizophrenia (SCZ) alone (cohort I): newly diagnosed with schizophrenia alone (e.g., met the claims-based diagnostic criteria for schizophrenia, but not for BD-I), 2) BD-SCZ (cohort II): met BD-I criteria only in the year prior to meeting the schizophrenia criteria, 3) SCZ-BD (cohort III): met schizophrenia criteria only in the year prior to, or on the same day as, meeting BD-I criteria, 4) BD-SCZ-BD (cohort IV) met BD-I criteria both in the year before and the year after meeting the schizophrenia criteria, and 5) BD alone (cohort V): newly diagnosed with BD-I alone (e.g., met the claims-based diagnostic criteria for BD-I, but not for schizophrenia). Descriptive statistics are reported for all cohorts. Results Of the 63,725 patients in the final analytic sample, 11.5% (n=7,336) had schizophrenia alone (cohort I), 7.7% (n=4,909) had a dual diagnosis (cohorts II-IV), and 80.8% (n=51,480) had BD-I alone (cohort V). The dual diagnosis patients included 1.0% (n=615) with BD-SCZ (cohort II), 2.8% (n=1,794) with SCZ-BD (cohort III), and 3.9% (n=2,500) with BD-SCZ-BD (cohort IV). Patients with different diagnosis patterns significantly differed in age, gender, and insurance type (p<.001). Considering the dual diagnosis cohorts, 927 received both diagnoses on the same day. Of those occurring on the same day, the majority (n=753) were on claims from the hospital/emergency department setting. Discussion This analysis of real-world data found a sizable number of patients with dual diagnoses of schizophrenia and BD-I. Among all patients with either BD-I, schizophrenia, or both, about 2/3 as many met the criteria for both disorders as for schizophrenia alone. Fifteen percent of patients who met criteria for both did so on the same day, likely reflecting patients presenting to acute care exhibiting mixed features. A review of medical records would be useful to determine if dual diagnosis is more common than suspected, and claims data should be examined to determine if these patients differ sufficiently from those with a single diagnosis to warrant exclusion from single-disease cohorts.