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Lin CW, Wen YW, Chen LK, Hsiao FY. Potentially high-risk medication categories and unplanned hospitalizations: a case-time-control study. Sci Rep 2017; 7:41035. [PMID: 28112193 PMCID: PMC5253626 DOI: 10.1038/srep41035] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 12/15/2016] [Indexed: 12/22/2022] Open
Abstract
Empirical data of medication-related hospitalization are very limited. We aimed to investigate the associations between 12 high risk medication categories (diabetic agents, diuretics, nonsteroidal anti-inflammatory drugs (NSAIDs), anticoagulants, antiplatelets, antihypertensives, antiarrhythmics, anticonvulsants, antipsychotics, antidepressants, benzodiazepine (BZD)/Z-hypnotics, and narcotics) and unplanned hospitalizations. A population-based case–time–control study was performed using Taiwan’s National Health Insurance Research Database. Patients who experienced an unplanned hospitalization (index visit) were identified as index subjects and matched to a randomly selected reference visit within users of a specific category of high-risk medication. An unplanned hospitalization was defined as a hospital admission immediately after an emergency department visit. Discordant exposures to the high-risk medication during the case period (1–14 days before the visit) and the control period (366–379 days before the visit) were examined in both index and reference visits. Antipsychotics was associated with the highest risk of unplanned hospitalizations (adjusted OR: 1.54, 95% CI [1.37–1.73]), followed by NSAIDs (1.50, [1.44–1.56]), anticonvulsants (1.34, [1.10–1.64]), diuretics (1.24, [1.15–1.33]), BZD/Z-hypnotics (1.23, [1.16–1.31]), antidepressants (1.17, [1.05–1.31]) and antiplatelets (1.16, [1.07–1.26]). NSAIDs and narcotics were associated with the highest risks of unplanned hospitalizations with a length of stay ≥10 days. These medication categories should be targeted for clinical and policy interventions.
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Affiliation(s)
- Chih-Wan Lin
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Wen Wen
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Liang-Kung Chen
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.,School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
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Buoli M, Kahn RS, Serati M, Altamura AC, Cahn W. Haloperidol versus second-generation antipsychotics in the long-term treatment of schizophrenia. Hum Psychopharmacol 2016; 31:325-31. [PMID: 27297936 DOI: 10.1002/hup.2542] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 05/04/2016] [Accepted: 05/04/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of the study was to compare antipsychotic monotherapies in terms of time to discontinuation in a sample of schizophrenia patients followed-up for 36 months. METHODS Two hundred and twenty schizophrenia patients, treated with antipsychotic monotherapy and followed-up in psychiatric outpatient clinics of Universities of Milan and Utrecht were included in the study. A survival analysis (Kaplan-Meier) of the 36-month follow-up period was performed to compare the single treatment groups. End-point was considered as discontinuation of treatment for recurrence, side effects or non-compliance. RESULTS Patients treated with haloperidol discontinued more than the other groups (Breslow: risperidone p < 0.001, olanzapine p < 0.001, quetiapine p = 0.002, clozapine p < 0.001, aripiprazole p = 0.002). Lack of efficacy (recurrence) was a more frequent reason for discontinuation in the haloperidol group than in the olanzapine group (p < 0.05). Extrapyramidal side effects (EPS) were more frequent in the haloperidol group than with olanzapine (p < 0.05). The olanzapine group presented more frequently weight gain than the other groups, without reaching statistical significance. CONCLUSIONS Patients treated with atypical antipsychotics appear to continue pharmacotherapy longer than patients treated with haloperidol. In addition, atypical antipsychotics seem to be more protective against recurrences than haloperidol. However, these results should be cautiously interpreted in the light of potential confounder factors such as duration of illness. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Massimiliano Buoli
- Department of Psychiatry, University of Milan, Milan, Italy.,Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - René S Kahn
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marta Serati
- Department of Psychiatry, University of Milan, Milan, Italy
| | | | - Wiepke Cahn
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
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Boonlue T, Subongkot S, Dilokthornsakul P, Kongsakon R, Pattanaprateep O, Suanchang O, Chaiyakunapruk N. Hospitalization and cost after switching from atypical to typical antipsychotics in schizophrenia patients in Thailand. CLINICOECONOMICS AND OUTCOMES RESEARCH 2016; 8:127-36. [PMID: 27199568 PMCID: PMC4857758 DOI: 10.2147/ceor.s97300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Several clinical practice guidelines suggest using atypical over typical antipsychotics in patients diagnosed with schizophrenia. Nevertheless, cost-containment policy urged restricting usage of atypical antipsychotics and switching from atypical to typical antipsychotics. Objective This study aimed to evaluate clinical and economic impacts of switching from atypical to typical antipsychotics in schizophrenia patients in Thailand. Methods From October 2010 through September 2013, a retrospective cohort study was performed utilizing electronic database of two tertiary hospitals. Schizophrenia patients aged 18 years or older and being treated with atypical antipsychotics were included. Patients were classified as atypical antipsychotic switching group if they switched to typical antipsychotics after 180 days of continual atypical antipsychotics therapy. Outcomes were schizophrenia-related hospitalization and total health care cost. Logistic and Poisson regression were used to evaluate the risk of hospitalization, and generalized linear model with gamma distribution was used to determine the health care cost. All analyses were adjusted by employing propensity score and multivariable analyses. All cost estimates were adjusted according to 2013 consumer price index and converted to US$ at an exchange rate of 32.85 Thai bahts/US$. Results A total of 2,354 patients were included. Of them, 166 (7.1%) patients switched to typical antipsychotics. The adjusted odds ratio for schizophrenia-related hospitalization in atypical antipsychotic switching group was 1.87 (95% confidence interval [CI] 1.23–2.83). The adjusted incidence rate ratio was 2.44 (95% CI 1.57–3.79) for schizophrenia-related hospitalizations. The average total health care cost was lower in patients with antipsychotic switching (−$64; 95% CI −$459 to $332). Conclusion Switching from atypical to typical antipsychotics is associated with an increased risk of schizophrenia-related hospitalization. Nonetheless, association with average total health care cost was not observed. These findings can be of use as a part of evidence in executing prospective cost-containment policy.
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Affiliation(s)
- Tuanthon Boonlue
- Clinical Pharmacy Division, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand; The College of Pharmacotherapy of Thailand, Nonthaburi, Thailand
| | - Suphat Subongkot
- Clinical Pharmacy Division, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand; The College of Pharmacotherapy of Thailand, Nonthaburi, Thailand
| | - Piyameth Dilokthornsakul
- Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; Center for Pharmaceutical Outcomes Research, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Ronnachai Kongsakon
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Oraluck Pattanaprateep
- Department of Health Informatics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Orabhorn Suanchang
- Department of Pharmacy, Somdet Chaopraya Institute of Psychiatry, Bangkok, Thailand
| | - Nathorn Chaiyakunapruk
- Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; School of Pharmacy, Monash University Malaysia, Selangor, Malaysia; School of Population Health, University of Queensland, Brisbane, Australia; School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
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He X, Wu J, Jiang Y, Liu L, Ye W, Xue H, Montgomery W. Health care resource utilization and direct medical costs for patients with schizophrenia initiating treatment with atypical versus typical antipsychotics in Tianjin, China. BMC Health Serv Res 2015; 15:149. [PMID: 25880803 PMCID: PMC4419499 DOI: 10.1186/s12913-015-0819-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 03/23/2015] [Indexed: 11/10/2022] Open
Abstract
Background It is uncertain whether the extra acquisition costs of atypical antipsychotics over typical antipsychotics are offset by their other reduced resource use especially in hospital services in China. This study compared the psychiatric-related health care resource utilization and direct medical costs for patients with schizophrenia initiating atypical or typical antipsychotics in Tianjin, China. Methods Data were obtained from the Tianjin Urban Employee Basic Medical Insurance database (2008–2010). Adult patients with schizophrenia with ≥1 prescription for antipsychotics after ≥90-day washout and 12-month continuous enrollment after first prescription was included. Psychiatric-related resource utilization and direct medical costs of the atypical and typical cohorts were estimated during the 12-month follow-up period. Logistic regressions, ordinary least square (OLS), and generalized linear models (GLM) were employed to estimate differences of resource utilization and costs between the two cohorts. One-to-one propensity score matching was conducted as a sensitivity analysis. Results 1131 patients initiating either atypical (N = 648) or typical antipsychotics (N = 483) were identified. Compared with the typical cohort, the atypical cohort had a lower likelihood of hospitalization (45.8% vs. 56.7%, P < 0.001; adjusted OR: 0.58, P < 0.001) over the follow-up period. Medication costs for the atypical cohort were higher than the typical cohort ($438 vs. $187, P < 0.001); however, their non-medication medical costs were significantly lower ($1223 vs. $1704, P < 0.001). The total direct medical costs were similar between the atypical and typical cohorts before ($1661 vs. $1892, P = 0.100) and after matching ($1711 vs. 1868, P = 0.341), consistent with the results from OLS and GLM models for matched cohorts. Conclusions The atypical cohort had similar total direct medical costs compared to the typical cohort. Higher medication costs associated with atypical antipsychotics were offset by a reduction in non-medication medical costs, driven by fewer hospitalizations.
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Affiliation(s)
- Xiaoning He
- School of Pharmaceutical Science and Technology, Tianjin University, No 92 Weijin Road, Nankai District, Tianjin, China.
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, No 92 Weijin Road, Nankai District, Tianjin, China.
| | - Yawen Jiang
- Department of Clinical Pharmacy and Pharmaceutical Economics and Policy, School of Pharmacy, University of Southern California, Los Angeles, CA, USA.
| | - Li Liu
- Lilly Suzhou Pharmaceutical Company, Ltd., Shanghai, China.
| | - Wenyu Ye
- Lilly Suzhou Pharmaceutical Company, Ltd., Shanghai, China.
| | - Haibo Xue
- Lilly Suzhou Pharmaceutical Company, Ltd., Shanghai, China.
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Loch AA. Stigma and higher rates of psychiatric re-hospitalization: São Paulo public mental health system. BRAZILIAN JOURNAL OF PSYCHIATRY 2012; 34:185-92. [PMID: 22729415 DOI: 10.1590/s1516-44462012000200011] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 10/14/2011] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of this study was to assess re-hospitalization rates of individuals with psychosis and bipolar disorder and to study determinants of readmission. METHODS Prospective observational study, conducted in São Paulo, Brazil. One hundred-sixty-nine individuals with bipolar and psychotic disorder in need of hospitalization in the public mental health system were followed for 12 months after discharge. Their families were contacted by telephone and interviews were conducted at 1, 2, 6 and 12 months post-discharge to evaluate readmission rates and factors related. RESULTS One-year re-hospitalization rate was of 42.6%. Physical restraint during hospital stay was a risk factor (OR = 5.4-10.5) for readmission in most models. Not attending consultations after discharge was related to the 12-month point readmission (OR = 8.5, 95%CI 2.3-31.2) and to the survival model (OR = 3.2, 95%CI 1.5-7.2). Number of previous admissions was a risk factor for the survival model (OR = 6.6-11.9). Family's agreement with permanent hospitalization of individuals with mental illness was the predictor associated to readmission in all models (OR = 3.5-10.9) and resulted in shorter survival time to readmission; those readmitted were stereotyped as dangerous and unhealthy. CONCLUSIONS Family's stigma towards mental illness might contribute to the increase in readmission rates of their relatives with psychiatric disorders. More studies should be conducted to depict mechanisms by which stigma increases re-hospitalization rates.
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Affiliation(s)
- Alexandre Andrade Loch
- Department and Institute of Psychiatry, School of Medicine, Universidade de São Paulo, Brazil.
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Nationwide study of antipsychotic use among community-dwelling persons with Alzheimer's disease in Finland. Int Psychogeriatr 2011; 23:1623-31. [PMID: 21867581 DOI: 10.1017/s1041610211001621] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Antipsychotics continue to be widely used in the treatment of behavioral and psychological symptoms of dementia despite their limited effectiveness and well-known risks, including increased mortality. Our aim was to investigate the national pattern of antipsychotic use among community-dwelling persons with and without Alzheimer's disease (AD) in Finland. METHODS The Social Insurance Institution of Finland (SII) identified all persons with a verified diagnosis of AD in Finland on 31 December 2005. A control for each person with AD, matched in terms of age, sex and region of residence, was also identified. Data on reimbursed drug purchases in 2005 were extracted from the Finnish National Prescription Register. Conditional logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the use of antipsychotics. RESULTS The study population comprised 28,089 matched pairs of persons with and without AD (mean age 80.0 years, SD 6.8, 32.2% men). The annual prevalence of antipsychotic use was higher among persons with than without AD (22.1% vs. 4.4%, adjusted OR = 5.91; 95% CI 5.91-6.31). Among persons with AD, the prevalence of antipsychotic use was similar across all age groups. Of the antipsychotic users, 85.2% with AD and 51.3% without AD purchased second generation antipsychotics. Most antipsychotic prescriptions - 67.8% in the AD and 62.9% in the non-AD group - were generated in primary care situations. CONCLUSION One-fifth of persons with AD used antipsychotic drugs. Antipsychotic use was six times more prevalent among persons with AD than without AD. Most antipsychotics were prescribed by primary care physicians.
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Stoklosa J, Öngür D. Rational antipsychotic choice: weighing the risk of tardive dyskinesia and metabolic syndrome. Harv Rev Psychiatry 2011; 19:271-6. [PMID: 21916828 DOI: 10.3109/10673229.2011.614100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Joseph Stoklosa
- Harvard Medical School and McLean Hospital, Belmont, MA 02478, USA.
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