Sébastien Bineau

Benzodiazepine discontinuation with prolonged-release melatonin: hints from a German longitudinal prescription database

Objective: Prolonged-release (PR) melatonin is approved in Europe for the treatment of insomnia in patients aged 55 years and above. The objective of the study was to describe its prescription patterns and its impact on hypnotics use in routine clinical practice. Research design and methods: This is a retrospective study analyzing PR melatonin prescription data from a German longitudinal database (IMS® Disease Analyzer). All patients initiating PR melatonin over the 10 months after approval (April 2008 – February 2009) were included. Patients were classified according to their use of hypnotic benzodiazepines or benzodiazepine-like drugs (BZD/Z) in the 3-month period before and after PR melatonin initiation. Results: Of the 512 eligible patients, 380 (74%) were aged ≥ 55 years, 344 (67%) women and 112 (22%) previous BZD/Z users. Most of the latter (79/99, 79.8%) had used BZD/Z for at least 180 days. Approximately one-third (35/112, 31%) discontinued BZD/Z after PR melatonin initiation, and the BZD/Z discontinuation rate was higher in patients receiving two or three PR melatonin prescriptions than in patients receiving only one prescription (10/24 = 42% vs 25/88 = 28%, p = 0.21). Of the 400 patients without prior BZD/Z use, 39 (10%) received BZD/Z during the follow-up. Conclusions: Based on the observed 31% discontinuation rate, PR melatonin may help to facilitate BZD/Z discontinuation in older insomniacs.

Antidepressant switching patterns in the treatment of major depressive disorder: a General Practice Research Database (GPRD) Study

Aims: To investigate switching patterns of major antidepressant treatments and associated factors in a primary care adult population with major depressive disorder (MDD) using data from the General Practitioner Research Database (GPRD).

Economic evaluation of the impact of memantine on time to nursing home admission in the treatment of Alzheimer disease.

Objective: An observational study showed that combining memantine with a cholinesterase inhibitor (ChEI) treatment significantly delayed admission to nursing homes in patients with Alzheimer disease (AD). Our study aimed to evaluate the economic impact of the concomitant use of memantine and a ChEI, compared with a ChEI alone, in a Canadian population of patients with AD. Method: A cost-utility analysis using a Markov model during a 7-year time horizon was performed according to a societal and Canadian health care system perspective. The Markov model includes the following states: noninstitutionalized, institutionalized, and deceased. The model includes transition probabilities for institutionalization and death, adjusted with mortality rates specific to AD. Utilities associated with institutionalization and noninstitutionalization were included. For the health care system perspective, costs of medication as well as costs of care provided in the community and in nursing homes were considered. For the societal perspective, costs of direct care and supervision provided by caregivers were added. Results: From both perspectives, the concomitant use of a ChEI and memantine is a dominant strategy, compared with the use of a ChEI alone. On a per patient basis, there was a gain of 0.26 quality-adjusted life years with the treatment including memantine and cost decreases of Can

Quality of Life Depends on the Drinking Pattern in Alcohol-Dependent Patients

21 391 and Can

A Predictive Microsimulation Model to Estimate the Clinical Relevance of Reducing Alcohol Consumption in Alcohol Dependence

30 512, respectively, for the societal and health care system perspective. Conclusions: This economic evaluation indicates that institutionalization is the largest cost component in AD management and that the use of memantine, combined with a ChEI, to treat AD is a cost-effective alternative, compared with the use of a ChEI alone.

The impact of memantine and cholinesterase inhibitor initiation for Alzheimer disease on the use of antipsychotic agents: analysis using the Régie de l'Assurance Maladie du Québec database.

AIMS In patients with alcohol dependence, health-related quality of life (QOL) is reduced compared with that of a normal healthy population. The objective of the current analysis was to describe the evolution of health-related QOL in adults with alcohol dependence during a 24-month period after initial assessment for alcohol-related treatment in a routine practice setting, and its relation to drinking pattern which was evaluated across clusters based on the predominant pattern of alcohol use, set against the influence of baseline variables METHODS The Medical Outcomes Study 36-Item Short-Form Survey (MOS-SF-36) was used to measure QOL at baseline and quarterly for 2 years among participants in CONTROL, a prospective observational study of patients initiating treatment for alcohol dependence. The sample consisted of 160 adults with alcohol dependence (65.6% males) with a mean (SD) age of 45.6 (12.0) years. Alcohol use data were collected using TimeLine Follow-Back. Based on the participants reported alcohol use, three clusters were identified: 52 (32.5%) mostly abstainers, 64 (40.0%) mostly moderate drinkers and 44 (27.5%) mostly heavy drinkers. Mixed-effect linear regression analysis was used to identify factors that were potentially associated with the mental and physical summary MOS-SF-36 scores at each time point. RESULTS The mean (SD) MOS-SF-36 mental component summary score (range 0-100, norm 50) was 35.7 (13.6) at baseline [mostly abstainers: 40.4 (14.6); mostly moderate drinkers 35.6 (12.4); mostly heavy drinkers 30.1 (12.1)]. The score improved to 43.1 (13.4) at 3 months [mostly abstainers: 47.4 (12.3); mostly moderate drinkers 44.2 (12.7); mostly heavy drinkers 35.1 (12.9)], to 47.3 (11.4) at 12 months [mostly abstainers: 51.7 (9.7); mostly moderate drinkers 44.8 (11.9); mostly heavy drinkers 44.1 (11.3)], and to 46.6 (11.1) at 24 months [mostly abstainers: 49.2 (11.6); mostly moderate drinkers 45.7 (11.9); mostly heavy drinkers 43.7 (8.8)]. Mixed-effect linear regression multivariate analyses indicated that there was a significant association between a lower 2-year follow-up MOS-SF-36 mental score and being a mostly heavy drinker (-6.97, P < 0.001) or mostly moderate drinker (-3.34 points, P = 0.018) [compared to mostly abstainers], being female (-3.73, P = 0.004), and having a Beck Inventory scale score ≥8 (-6.54, P < 0.001), at baseline. The mean (SD) MOS-SF-36 physical component summary score was 48.8 (10.6) at baseline, remained stable over the follow-up and did not differ across the three clusters. Mixed-effect linear regression univariate analyses found that the average 2-year follow-up MOS-SF-36 physical score was increased (compared with mostly abstainers) in mostly heavy drinkers (+4.44, P = 0.007); no other variables tested influenced the MOS-SF-36 physical score. CONCLUSION Among individuals with alcohol dependence, a rapid improvement was seen in the mental dimension of QOL following treatment initiation, which was maintained during 24 months. Improvement was associated with the pattern of alcohol use, becoming close to the general population norm in patients classified as mostly abstainers, improving substantially in mostly moderate drinkers and improving only slightly in mostly heavy drinkers. The physical dimension of QOL was generally in the normal range but was not associated with drinking patterns.

PND43 IMPACT OF MEMANTINE TREATMENT INITIATION ON PSYCHOTROPICS USE: ANALYSES WITH THE RAMQ DATABASE

Background: Alcohol consumption is one of the most important factors for disease and disability in Europe. In clinical trials, nalmefene has resulted in a significant reduction in the number of heavy-drinking days (HDDs) per month and total alcohol consumption (TAC) among alcohol-dependent patients versus placebo. Methods: A microsimulation model was developed to estimate alcohol-attributable diseases and injuries in patients with alcohol dependence and to explore the clinical relevance of reducing alcohol consumption. Results: For all diseases and injuries considered, the number of events (inpatient episodes) increased with the number of HDDs and TAC per year. The model predicted that a reduction of 20 HDDs per year would result in 941 fewer alcohol-attributable events per 100,000 patients, while a reduction in intake of 3,000 g/year of pure alcohol (ethanol) would result in 1,325 fewer events per 100,000 patients. Conclusion: The potential gains of reducing consumption in alcohol-dependent patients were considerable.

PMH24 ASSESSMENT OF RESOURCE UTILISATION IN ADULTS DIAGNOSED WITH DEPRESSION IN THE UK:A GPRD-BASED STUDY

Objective: Patients with Alzheimer disease (AD) show a high incidence of behavioural and psychological symptoms of dementia, which often lead to the prescription of antipsychotics. Our study sought to assess the impact of the initiation of memantine or cholinesterase inhibitors (ChEls) on the use of antipsychotics. Method: A retrospective cohort study was conducted using data from the Quebec provincial health plan database. Patients included in our study had received a diagnosis of AD and were initial users of memantine or ChEls. The proportion of patients who used antipsychotics was estimated using prescription data dating back to 1 year before and to 1 year after the first prescription of memantine or ChEls. The difference between the slopes corresponding to the periods pre- and postmemantine or ChEls was analyzed using an interrupted time series design. Results: The percentage of antipsychotic users increased by 118.3% before and by 68.3% after initiation of a ChEl, and increased by 68.6% before and by 7.0% after initiation of memantine. Antipsychotic trends pre- and post-ChEl initiation were not statistically different (P = 0.89), while a statistical difference was observed when comparing the antipsychotic trends pre- and postmemantine initiation (P < 0.001). Conclusions: The initiation of memantine, unlike ChEls, has a notable stabilization effect on the prescription of antipsychotics in patients with AD.

The impact of memantine in combination with acetylcholinesterase inhibitors on admission of patients with Alzheimer’s disease to nursing homes: cost-effectiveness analysis in France

on a wide range. The increase of the mother’s educational level is in signifi cantly positive relationship with the DS person’s computing (khi2 = 14,314, p = 0,026), drawing/ writing (khi2 = 21,027, p = 0,002) and reading (khi2 = 22,169, p = 0.001) performance. It has a favourable effect on the development of the basic self-supporting skills (khi2 = 25,571, P < 0.001), and the DS person’s social connections. The majority of those lacking friends live with mothers with the lowest qualifi cation (khi2 = 9.799, p = 0.02). The level of happiness was measured on a four-grade scale. Owing to a mental retardation of medium gravity, surveying was carried out in an indirect way, by questioning the parents. The higher parental qualifi cations associated with happier DS people (khi2 = 17,344, p = 0.008). The parents’ educational levels are correlated (r = 0.609, P < 0.001). CONCLUSIONS: More qualifi ed parents provide supportive environment rich in stimuli. Higher level of development reduces the DS person’s dependence on others, increases their self-estimation, the level of happiness and through this the quality of life improves. It means a smaller burden on the health care system, the society and the family. However the professionals taking part in family support must be reminded that not every family can perform special child educational tasks independently, and they need more intensive family support.

Contents Vol. 20, 2014

ill population has been difficult. OBJECTIVES: To explore protective and risk factors for a later severe violent offense (i.e. forensic admission) among the mentally ill (schizophrenics) and to do thorough investigation for appropriate models. METHODS: Between 1998–2000, 308 forensic and general psychiatry patients were recruited to case-control study in Canada, Finland, Germany, and Sweden. An innovative greedy naive Bayesian (NB) algorithm P-Course was utilized to search generalized factors from national datasets into a merger model (naive Bayesian fusion). The evidence was assessed with posterior odds (PO) and the predictions with accuracy, diagnostic odds ratio (DOR), area under ROC curve (AUC), Gini coefficient and logarithmic loss (log score). The models were tested using leave-oneout cross-validations and substitution procedures in which data was divided into separate teaching and test sets. RESULTS: The most influential predictive risk factors for violent offence include violent behavior prior to the index hospitalization (PO 11.8; 95% credibility interval 5.9–30.3), biological father’s conviction (9.4; 4.7–20.0), no use of psychotropic medications before the age of 18 (7.7; 4.3–16.5), and biological father’s substance abuse (2.6; 1.7–4.1). The merger model indicates very good discriminative power (DOR from 30.25; AUC from 0.82; Gini from 0.63; log score below 0.65) as well as robustness and accuracy (Canadian 82.5%; Swedish 87.1%) for the test sets. CONCLUSIONS: The characteristics of biological father and no use of psychopharmaceuticals before the age of 18 among mentally ill were related to committing a later severe violent offense. The exploration and predictions were carried out with P-Course and the multinational merger NB model indicated high discriminatory power and robustness compared to previous studies.