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Klein CC, Modi AC, Welge JA, Fornari VM, Kurtz B, Blom TJ, Higdon C, Correll CU, DelBello MP. Adherence Rates and Barriers to Second-Generation Antipsychotic Medication Use in Youth with Bipolar Spectrum Disorders Who Have Overweight/Obesity. J Child Adolesc Psychopharmacol 2024; 34:353-358. [PMID: 38770645 DOI: 10.1089/cap.2024.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Objective: Youth with bipolar spectrum disorders (BSD) are frequently prescribed second-generation antipsychotics (SGAs). Nonadherence to treatment often results in increased mood symptoms and diminished quality of life. We examined SGA adherence rates and adherence barriers among youth who have overweight/obesity and are diagnosed with BSD enrolled in a multisite pragmatic clinical trial. Methods: SGA adherence and adherence barriers at baseline via patient- and caregiver report was assessed. Adherence was defined as taking ≥70% of prescribed SGA doses in the past week. The weighted Kappa statistic was used to measure child-caregiver agreement about adherence rates, barriers, and caregiver assistance. Regression analyses were used to examine associations of caregiver assistance, age, sex, race, insurance status, dosing frequency, and number of concomitant medications with adherence. Barriers to adherence were analyzed separately for youth and their caregivers, using logistic regression to assess associations between informant-reported barriers and informant-reported adherence. Results: Participants included 1485 patients and/or caregivers. At baseline, 88.6% of patients self-reported as adherent; 92.0% of caregivers reported their child was adherent. Concordance between patients and caregivers was moderate (k = 0.42). Approximately, 50% of the sample reported no adherence barriers. Frequently endorsed barriers included forgetting, side effects, being embarrassed to take medications, and preferring to do something else. Concordance between informants regarding adherence barriers was weak (k = 0.05-0.36). Patients and caregivers who did not endorse adherence barriers reported higher adherence than those who endorsed barriers. Male sex and having once daily dosing of medications were associated with lower adherence. Discussion: One-week patient- and caregiver-reported adherence was high in this sample. Half of the sample reported adherence barriers. Most commonly endorsed barriers were forgetting, side effects, being embarrassed, and preferring to do something else. Caregivers and patients have unique perspectives regarding adherence barriers. Understanding and addressing treatment barriers in clinical practice may facilitate adherence.
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Affiliation(s)
- Christina C Klein
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Avani C Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio, USA
| | - Jeffrey A Welge
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Victor M Fornari
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, USA
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Brian Kurtz
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio, USA
| | - Thomas J Blom
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Claudine Higdon
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, USA
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, USA
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, Berlin, Germany
- German Center for Mental Health (DZPG), Berlin, Germany
| | - Melissa P DelBello
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Shin G, Jang B, Bae G, Jeon HL, Bae S. The Impact of Payment Scheme Changes on Medication Adherence and Persistence of Patients Diagnosed with Depression in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11100. [PMID: 36078819 PMCID: PMC9517799 DOI: 10.3390/ijerph191711100] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
As of 1 July 2018, the Korean National Health Insurance Service (NHIS) changed the fee schedule for individual psychotherapy (IP). We sought to analyze the impact of the IP payment scheme changes on the medication adherence and persistence of patients diagnosed with depression in Korea. We utilized the NHIS claims database from 2017 to 2019. Patients who were newly diagnosed with depression and utilized IP and were prescribed antidepressants during the study period were included. Adherence was measured using the medication possession ratio (MPR), and persistence was measured using the length of therapy (LOT) during the follow-up period. Adherence and persistence during the pre-policy period (before the change of the payment scheme, from January 2018 until June 2018) and the post-policy period (after the change, from July 2018 until December 2019) were compared. During the study period, a total of 176,740 patients with depression were identified. The average MPR significantly increased from 0.20 to 0.33 in the pre- and post-policy periods, respectively (p < 0.001). The average LOT of the patients improved considerably from 36 to 56 days in the pre- and post-policy periods, respectively (p < 0.001). Poisson regression analysis showed that patients with depression who were female, 19-34 years of age (vs. 50-64 years or over 64 years), and in the post-policy period were significantly associated with greater adherence and persistence rates. Payment scheme changes were associated with an increased adherence and persistence of medication use among patients diagnosed with depression.
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Affiliation(s)
- Gyeongseon Shin
- College of Pharmacy, Ewha Womans University, Seoul 03760, Korea
| | - Bohwa Jang
- College of Pharmacy, Ewha Womans University, Seoul 03760, Korea
| | - Green Bae
- College of Pharmacy, Ewha Womans University, Seoul 03760, Korea
| | - Ha-Lim Jeon
- School of Pharmacy, Jeonbuk National University, Jeonju 54896, Korea
| | - SeungJin Bae
- College of Pharmacy, Ewha Womans University, Seoul 03760, Korea
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Lu CY, Busch AB, Zhang F, Madden JM, Callahan MX, LeCates RF, Wallace J, Foxworth P, Soumerai SB, Ross-Degnan D, Wharam JF. Impact of High-Deductible Health Plans on Medication Use Among Individuals With Bipolar Disorder. Psychiatr Serv 2021; 72:926-934. [PMID: 33971720 DOI: 10.1176/appi.ps.202000362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE High-deductible health plans (HDHPs) require substantial out-of-pocket spending for most services, although medications may be subject to traditional copayment arrangements. This study examined effects of HDHPs on medication out-of-pocket spending and use and quality of care among individuals with bipolar disorder. METHODS This quasi-experimental study used claims data (2003-2014) for a national sample of 3,532 members with bipolar disorder, ages 12-64, continuously enrolled for 1 year in a low-deductible plan (≤$500) and then for 1 year in an HDHP (≥$1,000) after an employer-mandated switch. HDHP members were matched to 18,923 contemporaneous individuals in low-deductible plans (control group). Outcome measures were out-of-pocket spending and use of bipolar disorder medications, psychotropics for other disorders, and all other medications and appropriate laboratory monitoring for psychotropics. RESULTS Relative to the control group, annual out-of-pocket spending per person for bipolar disorder medications increased 20.8% among HDHP members (95% confidence interval [CI]=14.9%-26.7%), and the absolute increase was $36 (95% CI=$25.9-$45.2). Specifically, out-of-pocket spending increased for antipsychotics (27.1%; 95% CI=17.4%-36.7%) and anticonvulsants (19.2%; 95% CI=11.9%-26.6%) but remained stable for lithium (-3.7%; 95% CI=-12.2% to 4.8%). No statistically significant changes were detected in use of bipolar disorder medications, other psychotropics, or all other medications or in appropriate laboratory monitoring for bipolar disorder medications. CONCLUSIONS HDHP members with bipolar disorder experienced a moderate increase in out-of-pocket spending for medications but preserved bipolar disorder medication use. Findings may reflect individuals' perceptions of the importance of these medications for their functioning and well-being.
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Affiliation(s)
- Christine Y Lu
- Department of Population Medicine, Division of Health Policy and Insurance Research, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu, Zhang, Madden, Callahan, LeCates, Wallace, Soumerai, Ross-Degnan, Wharam); McLean Hospital, Belmont, Massachusetts, and Department of Health Care Policy, Harvard Medical School, Boston (Busch); Department of Pharmacy and Health Systems Sciences, Northeastern University Bouvé College of Health Sciences, Boston (Madden); Depression and Bipolar Support Alliance, Chicago (Foxworth)
| | - Alisa B Busch
- Department of Population Medicine, Division of Health Policy and Insurance Research, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu, Zhang, Madden, Callahan, LeCates, Wallace, Soumerai, Ross-Degnan, Wharam); McLean Hospital, Belmont, Massachusetts, and Department of Health Care Policy, Harvard Medical School, Boston (Busch); Department of Pharmacy and Health Systems Sciences, Northeastern University Bouvé College of Health Sciences, Boston (Madden); Depression and Bipolar Support Alliance, Chicago (Foxworth)
| | - Fang Zhang
- Department of Population Medicine, Division of Health Policy and Insurance Research, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu, Zhang, Madden, Callahan, LeCates, Wallace, Soumerai, Ross-Degnan, Wharam); McLean Hospital, Belmont, Massachusetts, and Department of Health Care Policy, Harvard Medical School, Boston (Busch); Department of Pharmacy and Health Systems Sciences, Northeastern University Bouvé College of Health Sciences, Boston (Madden); Depression and Bipolar Support Alliance, Chicago (Foxworth)
| | - Jeanne M Madden
- Department of Population Medicine, Division of Health Policy and Insurance Research, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu, Zhang, Madden, Callahan, LeCates, Wallace, Soumerai, Ross-Degnan, Wharam); McLean Hospital, Belmont, Massachusetts, and Department of Health Care Policy, Harvard Medical School, Boston (Busch); Department of Pharmacy and Health Systems Sciences, Northeastern University Bouvé College of Health Sciences, Boston (Madden); Depression and Bipolar Support Alliance, Chicago (Foxworth)
| | - Matthew X Callahan
- Department of Population Medicine, Division of Health Policy and Insurance Research, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu, Zhang, Madden, Callahan, LeCates, Wallace, Soumerai, Ross-Degnan, Wharam); McLean Hospital, Belmont, Massachusetts, and Department of Health Care Policy, Harvard Medical School, Boston (Busch); Department of Pharmacy and Health Systems Sciences, Northeastern University Bouvé College of Health Sciences, Boston (Madden); Depression and Bipolar Support Alliance, Chicago (Foxworth)
| | - Robert F LeCates
- Department of Population Medicine, Division of Health Policy and Insurance Research, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu, Zhang, Madden, Callahan, LeCates, Wallace, Soumerai, Ross-Degnan, Wharam); McLean Hospital, Belmont, Massachusetts, and Department of Health Care Policy, Harvard Medical School, Boston (Busch); Department of Pharmacy and Health Systems Sciences, Northeastern University Bouvé College of Health Sciences, Boston (Madden); Depression and Bipolar Support Alliance, Chicago (Foxworth)
| | - Jamie Wallace
- Department of Population Medicine, Division of Health Policy and Insurance Research, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu, Zhang, Madden, Callahan, LeCates, Wallace, Soumerai, Ross-Degnan, Wharam); McLean Hospital, Belmont, Massachusetts, and Department of Health Care Policy, Harvard Medical School, Boston (Busch); Department of Pharmacy and Health Systems Sciences, Northeastern University Bouvé College of Health Sciences, Boston (Madden); Depression and Bipolar Support Alliance, Chicago (Foxworth)
| | - Phyllis Foxworth
- Department of Population Medicine, Division of Health Policy and Insurance Research, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu, Zhang, Madden, Callahan, LeCates, Wallace, Soumerai, Ross-Degnan, Wharam); McLean Hospital, Belmont, Massachusetts, and Department of Health Care Policy, Harvard Medical School, Boston (Busch); Department of Pharmacy and Health Systems Sciences, Northeastern University Bouvé College of Health Sciences, Boston (Madden); Depression and Bipolar Support Alliance, Chicago (Foxworth)
| | - Stephen B Soumerai
- Department of Population Medicine, Division of Health Policy and Insurance Research, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu, Zhang, Madden, Callahan, LeCates, Wallace, Soumerai, Ross-Degnan, Wharam); McLean Hospital, Belmont, Massachusetts, and Department of Health Care Policy, Harvard Medical School, Boston (Busch); Department of Pharmacy and Health Systems Sciences, Northeastern University Bouvé College of Health Sciences, Boston (Madden); Depression and Bipolar Support Alliance, Chicago (Foxworth)
| | - Dennis Ross-Degnan
- Department of Population Medicine, Division of Health Policy and Insurance Research, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu, Zhang, Madden, Callahan, LeCates, Wallace, Soumerai, Ross-Degnan, Wharam); McLean Hospital, Belmont, Massachusetts, and Department of Health Care Policy, Harvard Medical School, Boston (Busch); Department of Pharmacy and Health Systems Sciences, Northeastern University Bouvé College of Health Sciences, Boston (Madden); Depression and Bipolar Support Alliance, Chicago (Foxworth)
| | - J Frank Wharam
- Department of Population Medicine, Division of Health Policy and Insurance Research, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu, Zhang, Madden, Callahan, LeCates, Wallace, Soumerai, Ross-Degnan, Wharam); McLean Hospital, Belmont, Massachusetts, and Department of Health Care Policy, Harvard Medical School, Boston (Busch); Department of Pharmacy and Health Systems Sciences, Northeastern University Bouvé College of Health Sciences, Boston (Madden); Depression and Bipolar Support Alliance, Chicago (Foxworth)
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Niu X, Veeranki P, Dennen S, Dembek C, Laubmeier K, Liu Y, Williams GR, Loebel A. Hospitalization risk among adults with bipolar I disorder treated with lurasidone versus other oral atypical antipsychotics: a retrospective analysis of Medicaid claims data. Curr Med Res Opin 2021; 37:839-846. [PMID: 33682547 DOI: 10.1080/03007995.2021.1897557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare the risk of hospitalization for adult Medicaid beneficiaries with bipolar I disorder treated with lurasidone vs. other oral atypical antipsychotics (AAPs) as monotherapy. METHODS A retrospective cohort study of the IBM MarketScan Multi-State Medicaid Claims database identified adults with bipolar I disorder who initiated an AAP (index date) between 1 January 2014 and 30 June 2019. Patients were continuously enrolled 12 months pre- and 24 months post-index date. Each month during the post-index period was categorized as monotherapy with lurasidone, aripiprazole, olanzapine, quetiapine or risperidone, no/minimal treatment, or other. Marginal structural models were performed to estimate hospitalization risk and length of stay (LOS) (all-cause and bipolar I disorder-related) compared to lurasidone. RESULTS The analysis included 8262 adults. Compared to lurasidone, the adjusted odds ratios (aORs) of all-cause hospitalization were significantly higher for olanzapine (aOR = 1.60, 95% CI = 1.09-2.10) and quetiapine (aOR = 1.54, 95% CI = 1.18-1.89). The risk was significantly higher for bipolar I disorder-related hospitalization for quetiapine (aOR = 1.57, 95% CI = 1.10-2.04) and risperidone (aOR = 1.80, 95% CI = 1.04-2.56) compared to lurasidone. The bipolar I disorder-related LOS per 100 patient-months was more than twice as long for quetiapine (8.42 days) compared to lurasidone (3.97 days, p < .01). CONCLUSIONS Lurasidone-treated adult Medicaid patients with bipolar I disorder had significantly lower risk of all-cause hospitalization than those treated with olanzapine and quetiapine and lower risk of bipolar I disorder-related hospitalization than quetiapine and risperidone. Bipolar I disorder-related hospital LOS was significantly shorter for patients treated with lurasidone compared to quetiapine.
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Affiliation(s)
- Xiaoli Niu
- Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
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Niu X, Dennen S, Dembek C, Laubmeier K, Liu Y, Veeranki P, Tocco M, Williams GR. Hospitalization Risk for Adults with Bipolar I Disorder Treated with Oral Atypical Antipsychotics as Adjunctive Therapy with Mood Stabilizers: A Retrospective Analysis of Medicaid Claims Data. CURRENT THERAPEUTIC RESEARCH 2021; 94:100629. [PMID: 34306269 PMCID: PMC8296072 DOI: 10.1016/j.curtheres.2021.100629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/18/2021] [Indexed: 01/03/2023]
Abstract
Background: Atypical antipsychotics (AAPs) with mood stabilizers are recommended as a first-line treatment for patients with bipolar disorder. No studies have compared the inpatient health care resource utilization for patients with bipolar disorder treated with lurasidone as adjunctive therapy with mood stabilizers compared with other oral AAPs. Objective: To compare the risk of hospitalization for adult Medicaid beneficiaries with bipolar I disorder when treated with lurasidone compared with other oral AAPs as adjunctive therapy with mood stabilizers. Methods: This retrospective cohort study used the MarketScan Research Databases Multi-State Medicaid Database (IBM, Armonk, NY) claims data to assess patients with bipolar I disorder between January 1, 2014, and June 30, 2019. Adult patients who initiated oral AAP treatment with mood stabilizers (index date) and who were continuously enrolled 12 months before (pre-index) and 24 months after (post-index) the index date were included. Treatment categories assigned by patient-month included lurasidone, aripiprazole, olanzapine, quetiapine, risperidone, or ziprasidone with mood stabilizers; no/minimal treatment; AAP monotherapy; and other. Marginal structural models were performed to estimate the all-cause and psychiatric hospitalization rates and hospital length of stay associated with each adjunctive AAP therapy by controlling for both time-invariant and time-varying confounders. Results: Adults with bipolar I disorder (N = 11,426; mean age = 39.4 years; female=73%) treated with an adjunctive oral AAP with mood stabilizers during the index month were categorized into lurasidone (12%), aripiprazole (17%), olanzapine (7%), quetiapine (32%), risperidone (11%), ziprasidone (7%), or other (15%) treatment groups. The adjusted odds of all-cause and psychiatric hospitalization were significantly higher for olanzapine (all causes: adjusted odds ratio [aOR] = 1.59; 95% CI, 1.13-2.25; psychiatric: aOR = 1.61, 95% CI, 1.12-2.32), quetiapine (all-causes: aOR = 1.27, 95% CI, 1.01-1.58; psychiatric: aOR = 1.28, 95% CI, 1.02-1.59), and ziprasidone (all-causes: aOR = 1.68, 95% CI, 1.05-2.66; psychiatric: aOR = 1.55, 95% CI, 1.02-2.35) compared with lurasidone with mood stabilizers. The adjusted odds of all-cause and psychiatric hospitalizations were numerically lower for lurasidone compared with aripiprazole. The all-cause hospital length of stay per 100 patient-months was significantly higher for olanzapine (20.3 days) and quetiapine (16.0 days) compared with lurasidone (12.2 days, both P values < 0.05). Conclusions: In a Medicaid population, adults with bipolar I disorder treated with lurasidone as adjunctive therapy with mood stabilizers had significantly lower all-cause and psychiatric hospitalization rates compared with olanzapine, quetiapine, and ziprasidone. Fewer hospitalizations may reduce the economic burden associated with bipolar disorder. (Curr Ther Res Clin Exp. 2021; 82:XXX-XXX).
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Affiliation(s)
- Xiaoli Niu
- Sunovion Pharmaceuticals Inc, Marlborough, Massachusetts
| | | | - Carole Dembek
- Sunovion Pharmaceuticals Inc, Marlborough, Massachusetts
| | | | | | | | - Michael Tocco
- Sunovion Pharmaceuticals Inc, Marlborough, Massachusetts
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Doane MJ, Ogden K, Bessonova L, O'Sullivan AK, Tohen M. Real-World Patterns of Utilization and Costs Associated with Second-Generation Oral Antipsychotic Medication for the Treatment of Bipolar Disorder: A Literature Review. Neuropsychiatr Dis Treat 2021; 17:515-531. [PMID: 33623386 PMCID: PMC7896797 DOI: 10.2147/ndt.s280051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/06/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Treatment with second-generation antipsychotics (SGAs) for bipolar disorder, including bipolar I disorder (BD-I), is common. This review evaluated real-world utilization patterns with oral SGAs in the United States (US) for bipolar disorder (and BD-I specifically when reported) and economic burden associated with these patterns. METHODS Structured, systematic searches of MEDLINE®, EMBASE®, and National Health Service Economic Evaluation Database identified primary research studies (published 2008-2018) describing real-world SGA use in adults with bipolar disorder/BD-I. RESULTS Among 769 studies screened, 39 met inclusion criteria. Most studies (72%) were analyses of commercial or Medicare/Medicaid claims databases. Patient-related (eg, demographic, comorbidities) and disease-related (eg, mania, psychosis) factors were associated with prescribed SGA. Suboptimal utilization patterns (ie, nonadherence, nonpersistence, treatment gaps, medication switching, and discontinuation) were common for patients treated with SGAs. Also common were SGAs prescribed with another psychotropic medication and SGA combination treatment (use of ≥2 SGAs concurrently). Suboptimal adherence and SGA combination treatment were both associated with increased health care resource use (HCRU); suboptimal adherence was associated with higher total direct medical and indirect costs. LIMITATIONS Different definitions for populations and concepts limited between-study comparisons. Focusing on SGAs limits contextualizing findings within the broader treatment landscape (eg, lithium, anticonvulsants). Given the nature of claims data, prescribing rationale (eg, acute episodes vs maintenance) and factors influencing observed utilization patterns could not be fully derived. CONCLUSION Despite increased use of SGAs to treat bipolar disorder over the last decade, reports of suboptimal utilization patterns of SGAs (eg, nonadherence, nonpersistence) were common as was combination treatment. Patterns of SGA use associated with additional HCRU and/or costs were suboptimal adherence and SGA combination treatment; economic consequences associated with other utilization patterns (eg, nonpersistence) were unclear. Strategies to improve SGA treatment continuity, particularly adherence, may improve clinical and economic outcomes among people living with bipolar disorder.
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Affiliation(s)
- Michael J Doane
- Health Economics and Outcomes Research, Alkermes, Inc., Waltham, MA, USA
| | - Kristine Ogden
- Evidence, Worldwide Clinical Trials, Morrisville, NC, USA
| | - Leona Bessonova
- Health Economics and Outcomes Research, Alkermes, Inc., Waltham, MA, USA
| | - Amy K O'Sullivan
- Health Economics and Outcomes Research, Alkermes, Inc., Waltham, MA, USA
| | - Mauricio Tohen
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, USA
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Huang H, Schmerold L, Dembek C, Fan Q, Dieyi C, Williams GR, Loebel A. Healthcare resource utilization, costs and treatment patterns in patients with bipolar disorder treated with lurasidone or cariprazine. J Med Econ 2021; 24:352-362. [PMID: 33588674 DOI: 10.1080/13696998.2021.1890428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare healthcare resource utilization (HCRU), costs, and treatment adherence and persistence for patients with bipolar disorder treated with lurasidone or cariprazine. METHODS Adult patients with bipolar disorder who initiated lurasidone or cariprazine as monotherapy or adjunctive therapy between 1 January 2016 and 30 June 2019 were identified from the IBM MarketScan Commercial and Medicare Supplemental Database. The date of the first claim for lurasidone or cariprazine was defined as the index date. A difference-in-difference (DID) analysis, which mitigated bias by using each cohort as its own control, compared the changes in HCRU and costs from 6-months pre-treatment (baseline) to 6-months post-treatment (follow-up) between the two cohorts. Treatment adherence (medication possession ratio and proportion of days covered) and persistence (time to discontinuation) were assessed during the 6-month post-treatment period. Adjusted analyses were conducted using inverse probability of treatment weighting on HCRU, costs, and time to discontinuation. RESULTS A total of 16,683 patients treated with lurasidone and 4,128 patients treated with cariprazine were identified. Average age (39-40) and proportion female (68-71%) were similar between cohorts. Both cohorts had reductions in hospitalizations from baseline to follow-up, and the decrease was significantly greater for the lurasidone cohort compared to the cariprazine cohort (change in the proportions of patients with all-cause hospitalizations: -5.3% vs. -2.5%, DID = -2.8%, p<.001). The total healthcare costs increased from baseline to follow-up in both cohorts, and the increase was significantly lower for the lurasidone cohort (change in total all-cause healthcare cost per person: $3,413 vs. $4,642, DID=-$1,228, p = .022). The lurasidone cohort had significantly lower risk of discontinuing treatment (hazard ratio = 0.86, p<.001) than the cariprazine cohort. CONCLUSIONS Patients with bipolar disorder treated with lurasidone had greater reductions in hospitalizations from 6-months pre-treatment to 6-months post-treatment and had a lower increase in total costs compared to patients treated with cariprazine.
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Affiliation(s)
- Huan Huang
- Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
| | | | | | - Qi Fan
- Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
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8
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Bessonova L, Ogden K, Doane MJ, O'Sullivan AK, Tohen M. The Economic Burden of Bipolar Disorder in the United States: A Systematic Literature Review. CLINICOECONOMICS AND OUTCOMES RESEARCH 2020; 12:481-497. [PMID: 32982338 PMCID: PMC7489939 DOI: 10.2147/ceor.s259338] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/12/2020] [Indexed: 12/15/2022] Open
Abstract
Bipolar disorder (BD) is a mood disorder with subtypes characterized by episodes of mania, hypomania, and/or depression. BD is associated with substantial economic burden, and the bipolar I disorder (BD-I) subtype is associated with high medical costs. This review further evaluated the economic burden of BD and BD-I in the United States (US), describing health-care resource utilization (HCRU) and sources of direct medical and indirect costs. Data were obtained from systematic searches of MEDLINE®, EMBASE®, and National Health Service Economic Evaluation Database. Citations were screened to identify primary research studies (published 2008-2018) on the economic burden of BD/BD-I or its treatment in real-world settings. Reported costs were converted to 2018 US dollars. Of identified abstracts (N=4111), 56 studies were included. The estimated total annual national economic burden of BD/BD-I was more than $195 billion, with approximately 25% attributed to direct medical costs. Individuals with BD/BD-I used health-care services more frequently and had higher direct medical costs than matched individuals without the disease. Drivers of higher direct costs included frequent psychiatric interventions, presence of comorbid medical/psychiatric conditions, and both suboptimal medication adherence and clinical management. Indirect costs (eg, unemployment, lost work productivity for patients/caregivers) accounted for 72-80% of the national economic burden of BD/BD-I. Different definitions for study populations and cost categories limited comparisons of economic outcomes. This review builds on existing literature describing the economic burden of BD and confirmed cost drivers of BD/BD-I. Improved clinical management of BD/BD-I and associated comorbidities, together with better medication adherence, may reduce health-care costs and improve patient outcomes.
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Affiliation(s)
- Leona Bessonova
- Health Economics and Outcomes Research, Alkermes, Inc., Waltham, MA, USA
| | - Kristine Ogden
- Evidence, Worldwide Clinical Trials, Morrisville, NC, USA
| | - Michael J Doane
- Health Economics and Outcomes Research, Alkermes, Inc., Waltham, MA, USA
| | - Amy K O'Sullivan
- Health Economics and Outcomes Research, Alkermes, Inc., Waltham, MA, USA
| | - Mauricio Tohen
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, USA
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Bessonova L, Velligan DI, Weiden PJ, O’Sullivan AK, Yarlas A, Bayliss M, Baranwal N, Rychlec K, Carpenter-Conlin J, Doane MJ, Sajatovic M. Antipsychotic treatment experiences of people with bipolar I disorder: patient perspectives from an online survey. BMC Psychiatry 2020; 20:354. [PMID: 32631362 PMCID: PMC7371473 DOI: 10.1186/s12888-020-02767-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/25/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Oral antipsychotic (AP) medications are frequently prescribed to people with bipolar I disorder (BD-I). A cross-sectional online survey examined the experiences of people living with BD-I with a history of recent AP use. METHODS Adults with self-reported physician-diagnosed BD-I (N = 200) who received oral APs during the prior year completed a survey on AP-related experiences, including side effects and their perceived burden on social functioning, adherence, and work. Items also assessed preferences for trade-offs (balancing symptom management and side effects) when considering a hypothetical new AP. The perceived impact of specific, prevalent side effects on adherence, work, and preferences for a hypothetical AP were also examined. Analyses were descriptive. RESULTS The survey sample had a mean age of 43.2 (SD = 12.4) years, was 60% female, and 31% nonwhite. Almost all participants (98%) had experienced AP side effects. Common self-reported side effects were feeling drowsy or tired (83%), lack of emotion (79%), anxiety (79%), dry mouth (76%), and weight gain (76%). Weight gain was cited as the most bothersome side effect, rated by most participants (68%) as "very" or "extremely bothersome." Nearly half of participants (49%) reported that AP side effects negatively impacted their job performance; almost all (92%) reported that side effects - most commonly anxiety and lack of emotion - negatively impacted social relationships (e.g., family or romantic partners). The most commonly-reported reason for stopping AP use was dislike of side effects (48%). Side effects most likely to lead to stopping or taking less of AP treatment included "feeling like a 'zombie'" (29%), feeling drowsy or tired (25%), and weight gain (24%). When considering a hypothetical new AP, the most common side effects participants wanted to avoid included AP-induced anxiety (50%), weight gain (48%), and "feeling like a 'zombie'" (47%). CONCLUSIONS Side effects of APs were both common and bothersome, and impacted social functioning, adherence, and work. Findings highlight the prevailing unmet need for new APs with more favorable benefit-risk profiles.
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Affiliation(s)
| | - Dawn I. Velligan
- grid.267309.90000 0001 0629 5880The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX USA
| | - Peter J. Weiden
- grid.422303.40000 0004 0384 9317Alkermes, Inc., 852 Winter Street, Waltham, MA USA
| | - Amy K. O’Sullivan
- grid.422303.40000 0004 0384 9317Alkermes, Inc., 852 Winter Street, Waltham, MA USA
| | - Aaron Yarlas
- grid.423532.10000 0004 0516 8515Optum, 1301 Atwood Avenue, Johnston, RI USA
| | - Martha Bayliss
- grid.423532.10000 0004 0516 8515Optum, 1301 Atwood Avenue, Johnston, RI USA
| | - Nishtha Baranwal
- grid.423532.10000 0004 0516 8515Optum, 1301 Atwood Avenue, Johnston, RI USA
| | - Kaitlin Rychlec
- grid.423532.10000 0004 0516 8515Optum, 1301 Atwood Avenue, Johnston, RI USA
| | | | - Michael J. Doane
- grid.422303.40000 0004 0384 9317Alkermes, Inc., 852 Winter Street, Waltham, MA USA
| | - Martha Sajatovic
- grid.443867.a0000 0000 9149 4843University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH USA
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10
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Klein CC, Topalian AG, Starr B, Welge J, Blom T, Starr C, Deetz I, Turner H, Sage J, Utecht J, Fornari V, Patino Duran L, Higdon C, Sutton JJ, Sorter MT, Correll CU, DelBello MP. The Importance of Second-Generation Antipsychotic-Related Weight Gain and Adherence Barriers in Youth with Bipolar Disorders: Patient, Parent, and Provider Perspectives. J Child Adolesc Psychopharmacol 2020; 30:376-380. [PMID: 32423240 DOI: 10.1089/cap.2019.0184] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives: The objective of this research was to understand physician, patient, and parent perspectives on barriers to second-generation antipsychotic (SGA) medication adherence in youth with bipolar spectrum disorders, and attitudes toward treatment of SGA-related weight gain. Methods: Patients diagnosed with bipolar disorder before age 18, parents of children diagnosed before 18, and clinicians with experience prescribing SGAs for these patients completed surveys regarding SGA-related side effects, adherence barriers, and acceptability of weight management strategies. Results: Patients (n = 225), parents (n = 128), and clinicians (n = 54) reported weight gain as the most concerning SGA-related side effect (45.6%, 38.9%, and 70.4%, respectively). Weight gain was also the top adherence barrier for patients (35.9%), but was ranked fourth (41.8%) by parents. Patients (61.5%) were more likely "definitely" willing to co-initiate another medication to manage weight gain upon SGA initiation than parents (20.1%) or clinicians (1.9%). Conversely, parents (54.9%) and clinicians (84.9%) were "definitely" willing to accept/prescribe a second medication aiming to reverse weight gain of ≥10 lbs., and patients (61.1%) were willing to add another medication to reverse any weight gain. Conclusion: SGA-related weight gain impairs medication adherence in young patients with bipolar disorder. Many young patients would start pharmacologic treatment to mitigate SGA-related weight gain at treatment initiation, parents and clinicians are more hesitant. This research informs patient-centered perspectives on SGA adherence barriers and strategies to minimize potential side effects, which may improve adherence in this vulnerable patient population.
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Affiliation(s)
- Christina C Klein
- Division of Bipolar Disorders Research, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Alique G Topalian
- Division of Bipolar Disorders Research, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Brian Starr
- Division of Bipolar Disorders Research, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jeffrey Welge
- Division of Bipolar Disorders Research, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Thomas Blom
- Division of Bipolar Disorders Research, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Cindy Starr
- Mayfield Brain and Spine, Cincinnati, Ohio, USA
| | - Ingrid Deetz
- Depression and Bipolar Support Alliance, Chicago, Illinois, USA
| | - Heather Turner
- National Alliance on Mental Illness, Southwest Ohio, Cincinnati, Ohio, USA
| | - Jessica Sage
- Division of Child and Adolescent Psychiatry, Cincinnati, Ohio, USA
| | - Jenna Utecht
- Division of Bipolar Disorders Research, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Victor Fornari
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra, Hempstead, New York, USA
- Department of Psychiatry, The Zucker Hillside Hospital and Zucker School of Medicine at Hofstra, Hempstead, New York, USA
| | - Luis Patino Duran
- Division of Bipolar Disorders Research, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Claudine Higdon
- Department of Psychiatry, The Zucker Hillside Hospital and Zucker School of Medicine at Hofstra, Hempstead, New York, USA
| | - John J Sutton
- Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio, USA
| | - Michael T Sorter
- Division of Child and Adolescent Psychiatry, Cincinnati, Ohio, USA
| | - Christoph U Correll
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra, Hempstead, New York, USA
- Department of Psychiatry, The Zucker Hillside Hospital and Zucker School of Medicine at Hofstra, Hempstead, New York, USA
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité Universitätsmedizin, Berlin, Germany
| | - Melissa P DelBello
- Division of Bipolar Disorders Research, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Mauri MC, Reggiori A, Minutillo A, Franco G, Pace CD, Paletta S, Cattaneo D. Paliperidone LAI and Aripiprazole LAI Plasma Level Monitoring in the
Prophylaxis of Bipolar Disorder Type I with Manic Predominance. PHARMACOPSYCHIATRY 2020; 53:209-219. [DOI: 10.1055/a-1113-7862] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Abstract
Introduction The objective of this study was the evaluation of utility of
plasma level monitoring in the clinical stabilizing efficacy and tolerability of
paliperidone palmitate (PP) vs. aripiprazole monohydrate (AM) in bipolar
disorder I (BD I) with manic predominance.
Methods Fifty-six outpatients of both sexes, age ranging from 18 to 65
years, affected by BD I with manic predominance, orally treated and stabilized
after acute episode for at least 2 weeks with paliperidone or aripiprazole
(n=31, paliperidone; n=25, aripiprazole) underwent a prospective
observational study of switching to the corresponding long-acting injection
(LAI) on the basis of clinical evaluation. The efficacy and tolerability of the
2 treatments were assessed by BPRS, PANSS, HAMD21, and MRS rating scales and a
check list every month for 12 months. Drug plasma levels determinations (PLs)
were performed at the same times.
Results A good clinical stability and tolerability of both drugs were
reported. Lower mean PLs of PP showed a positive effect on depressive symptoms.
AM PLs variability was associated with greater instability of manic symptoms
whereas intermediate PLs seem to have more influence on depressive
symptomatology.
Discussion PLs drug monitoring has been proven to be useful, and further
investigations to identify optimal therapeutic ranges for LAI formulations are
needed.
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Affiliation(s)
- Massimo Carlo Mauri
- Department of Neurosciences and Mental Health, Fondazione IRCCS
Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Neurosciences and Mental Health, Psychopharmacology Unit,
Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan,
Italy
| | - Alessandra Reggiori
- Department of Neurosciences and Mental Health, Fondazione IRCCS
Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Neurosciences and Mental Health, Psychopharmacology Unit,
Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan,
Italy
| | - Alessandro Minutillo
- Department of Neurosciences and Mental Health, Fondazione IRCCS
Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Neurosciences and Mental Health, Psychopharmacology Unit,
Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan,
Italy
| | - Gemma Franco
- Department of Neurosciences and Mental Health, Fondazione IRCCS
Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Neurosciences and Mental Health, Psychopharmacology Unit,
Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan,
Italy
| | - Chiara Di Pace
- Department of Neurosciences and Mental Health, Fondazione IRCCS
Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Neurosciences and Mental Health, Psychopharmacology Unit,
Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan,
Italy
| | - Silvia Paletta
- Department of Neurosciences and Mental Health, Fondazione IRCCS
Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Neurosciences and Mental Health, Psychopharmacology Unit,
Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan,
Italy
| | - Dario Cattaneo
- Unit of Clinical Pharmacology, L. Sacco University Hospital, Milano,
Italy
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12
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Fleury MJ, Rochette L, Grenier G, Huỳnh C, Vasiliadis HM, Pelletier É, Lesage A. Factors associated with emergency department use for mental health reasons among low, moderate and high users. Gen Hosp Psychiatry 2019; 60:111-119. [PMID: 31404825 DOI: 10.1016/j.genhosppsych.2019.07.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 07/05/2019] [Accepted: 07/08/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study identified factors associated with frequency of emergency department (ED) use for mental health (MH) reasons in Quebec during 2015-2016. METHODS Participants (n = 115,066) were categorized as: 1) low (1 visit/year; 76%); 2) moderate (2 visits/year; 14%); and 3) high (3+ visits/year; 10%) ED users. Independent variables included predisposing, enabling and needs factors based on the Andersen Behavioral Model. Variables significantly associated with frequency of ED use were entered into a multinomial logistic regression. RESULTS Patients with mental illness (MI), especially substance-related disorders (SRD) and schizophrenia spectrum disorders; bipolar, depressive, anxiety or personality disorders; and those with severe chronic physical illness (needs factors) were more likely to use ED for MH reasons, as were male participants 18-64 years old, and those living in metropolitan areas with high social or material deprivation (predisposing factors). Regarding enabling factors, consultations with outpatient psychiatrists and not seeing a general practitioner (GP) in the year prior to ED visit were associated with high ED use. CONCLUSION The severity of MI/SRD contributed most to frequent ED use, while social and material deprivation in metropolitan areas, and intensity of medical care also influenced ED use for MH reasons.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, Montreal, QC, Canada; Douglas Mental Health University Institute, Montréal, QC, Canada.
| | - Louis Rochette
- Insitut national de santé publique du Québec, Québec, QC, Canada
| | - Guy Grenier
- Douglas Mental Health University Institute, Montréal, QC, Canada
| | - Christophe Huỳnh
- University Institute on Addictions, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada; Department of Psychiatry, University of Montreal, Montréal, QC, Canada; School of Psychoeducation, University of Montreal, Montréal, QC, Canada
| | - Helen-Maria Vasiliadis
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, QC, Canada; Centre de recherche Charles LeMoyne - Saguenay-Lac-Saint-Jean sur les innovations en santé, Longueuil, QC, Canada
| | - Éric Pelletier
- Insitut national de santé publique du Québec, Québec, QC, Canada
| | - Alain Lesage
- Department of Psychiatry, University of Montreal, Montréal, QC, Canada; Centre de recherche Fernand-Séguin, Institut universitaire en santé mentale de Montréal, Montréal, QC, Canada
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13
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Ng-Mak D, Halpern R, Rajagopalan K, Loebel A. Hospitalization risk in bipolar disorder patients treated with lurasidone versus other atypical antipsychotics. Curr Med Res Opin 2019; 35:211-219. [PMID: 29625538 DOI: 10.1080/03007995.2018.1462787] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This observational study compared the risk of hospitalization for patients with bipolar disorder when treated with lurasidone versus other oral atypical antipsychotics. METHODS This US commercial claims analysis (4 April 2010 through 24 September 2014) used the Optum Research Database to identify adult patients with bipolar disorder treated with oral atypical antipsychotics (N = 11,132). The first claim for an atypical antipsychotic defined the index date, with pre-index and post-index periods of 180 and 360 days, respectively. Every month of the post-index period was categorized as monotherapy treatment with lurasidone, aripiprazole, olanzapine, quetiapine, risperidone, ziprasidone, no/minimal treatment or other. Starting with the initial month of treatment, the risk of psychiatric or all-cause hospitalization in the subsequent month was examined based on treatment in the current month and pre-index covariates (age, gender, hospitalizations, emergency room visits, diagnoses for anxiety, alcohol abuse, substance abuse, hypertension, type 2 diabetes and obesity) and time-varying versions of the pre-index covariates using a marginal structural model. RESULTS After controlling for covariates, relative to lurasidone, the odds of psychiatric and all-cause hospitalization, respectively, were 2-3 times higher for olanzapine (odds ratio [OR] = 2.78, CI 1.09, 7.08, p = .032; OR = 3.20, CI 1.24, 8.26, p = .016), quetiapine (OR = 2.80, CI 1.13, 6.95, p = .026; OR = 3.23, CI 1.29, 8.11, p = .013), risperidone (OR = 2.50, CI 1.01, 6.21, p = .048; OR = 2.79, CI 1.11, 7.02, p = .029), aripiprazole (OR = 2.13, CI 0.87, 5.20, p = .097; OR = 2.57, CI 1.04, 6.37, p = .041) and ziprasidone (OR =2.31, CI 0.91, 5.85, p = .079; OR = 2.49, CI 0.97, 6.40, p = .058). CONCLUSIONS In this claims database analysis, lurasidone-treated patients with bipolar disorder had a significantly lower risk of psychiatric hospitalization compared to quetiapine, olanzapine and risperidone, but not aripiprazole or ziprasidone. Lurasidone-treated patients had a significantly lower risk of all-cause hospitalization compared to quetiapine, olanzapine, risperidone and aripiprazole, but not ziprasidone.
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Affiliation(s)
- Daisy Ng-Mak
- a Sunovion Pharmaceuticals Inc. , Marlborough , MA , USA
| | - Rachel Halpern
- b Optum, Health Analytics and Outcomes Research , Eden Prairie , MN , USA
| | | | - Antony Loebel
- c Sunovion Pharmaceuticals Inc. , Fort Lee , NJ , USA
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14
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Augusto M, Greene M, Touya M, Sweeney SM, Waters H. Cost–effectiveness of long-acting injectable aripiprazole once-monthly 400 mg in bipolar I disorder in the USA. J Comp Eff Res 2018; 7:637-650. [DOI: 10.2217/cer-2018-0010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To evaluate the cost–effectiveness of aripiprazole once-monthly 400/300 mg (AOM 400) in maintenance monotherapy treatment of bipolar I disorder (BP-I). Methods: A de novo lifetime Markov model was developed for BP-I using available data for AOM 400 and relevant comparators. Base-case analysis considered costs and outcomes from the US payer perspective. Results: The cost per quality-adjusted life year gained with AOM 400 versus comparators ranged from US$2007 versus oral asenapine to dominance (i.e., lower cost with quality-adjusted life gain) versus long-acting injectable risperidone, paliperidone palmitate, oral cariprazine and best supportive care. Patients treated with AOM 400 were estimated to have fewer mood episodes and hospitalizations per patient (5.37) than comparators (6.33, asenapine or cariprazine; 6.54, risperidone long-acting injectable; 7.64, paliperidone palmitate; and 8.93, best supportive care). Sensitivity analyses showed results were robust to parameter uncertainty. Conclusion: AOM 400 may be considered cost effective in the maintenance monotherapy treatment of BP-I in adults.
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Affiliation(s)
| | - Mallik Greene
- Otsuka Pharmaceutical Development & Commercialization Inc., Princeton, NJ, USA
| | | | | | - Heidi Waters
- Otsuka Pharmaceutical Development & Commercialization Inc., Princeton, NJ, USA
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15
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Tsoutsoulis K, Maxwell A, Menon Tarur Padinjareveettil A, Zivkovic F, Rogers JM. Impact of inpatient mental health rehabilitation on psychiatric readmissions: a propensity score matched case control study. J Ment Health 2018; 29:532-540. [DOI: 10.1080/09638237.2018.1466049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Katrina Tsoutsoulis
- School of Psychology, Australian Catholic University, Melbourne, VIC, Australia,
| | - Anna Maxwell
- School of Psychology, Australian Catholic University, Melbourne, VIC, Australia,
| | - Aparna Menon Tarur Padinjareveettil
- South Eastern Sydney Local Health District, Sydney, NSW, Australia, and
- School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia
| | - Frank Zivkovic
- South Eastern Sydney Local Health District, Sydney, NSW, Australia, and
| | - Jeffrey M. Rogers
- South Eastern Sydney Local Health District, Sydney, NSW, Australia, and
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16
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Augusto M, Greene M, Touya M, Sweeney SM, Waters H. Budget impact analysis of long-acting injectable aripiprazole once-monthly 400 mg in bipolar I disorder in the USA. J Comp Eff Res 2018; 7:627-636. [PMID: 29694243 DOI: 10.2217/cer-2018-0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To estimate the budget impact (BI) of introducing aripiprazole once-monthly 400 mg/300 mg (AOM 400) in the maintenance monotherapy treatment of bipolar I disorder versus long-acting injectables, oral antipsychotics and best supportive care. METHODS A BI model was developed from a US-payer perspective using treatment-related, hospitalization and adverse event management cost estimates for a hypothetical 1,000,000-member health plan over a 5-year period. RESULTS Market share of AOM 400 was predicted to increase from 0.6% in Year 1 (current scenario) to 1.3% in Year 5 (predicted scenario), with predicted increases for paliperidone palmitate, asenapine and cariprazine. Treatment-related costs explained the BI increase, while adverse event and hospitalization costs were reduced. The per member per month incremental cost ranged from US$0.06 to US$0.26 in Years 1-5. The largest increases were predicted for paliperidone palmitate. CONCLUSION As market shares of atypical antipsychotics are predicted to increase, payers may wish to re-evaluate their use.
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Affiliation(s)
| | - Mallik Greene
- Otsuka Pharmaceutical Development & Commercialization Inc., Princeton, NJ, USA
| | | | | | - Heidi Waters
- Otsuka Pharmaceutical Development & Commercialization Inc., Princeton, NJ, USA
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17
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Patterns of Prescription of Psychotropic Medications and Their Adherence among Patients with Schizophrenia in Two Psychiatric Hospitals in Accra, Ghana: A Cross-Sectional Survey. PSYCHIATRY JOURNAL 2018. [PMID: 29536020 PMCID: PMC5817813 DOI: 10.1155/2018/9850594] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Patients with schizophrenia are managed with antipsychotics and other psychotropic medications. Objectives This study aimed to assess the commonly prescribed psychotropic medications for patients with schizophrenia, explore the types of therapeutic monitoring that were performed, and find out whether the side effects experienced by the patients played any role in their adherence behaviour. Methods This hospital-based cross-sectional study enrolled 259 patients with schizophrenia from Accra Psychiatric Hospital and Pantang Psychiatric Hospital. Data were collected on mental status, side effects, types of therapeutic monitoring performed, and adherence behaviour. Results Olanzapine was the commonly prescribed psychotropic medication. Most of respondents (73.4%) experienced mild levels of side effects. The negative effects were predominantly genitourinary (26%) and gastrointestinal (17.2%). Blood pressure and heart rate measures were the main types of monitoring performed but no measurement of drug levels was reported. About 98.1% of the participants poorly adhered to their medications and the major reasons for poor adherence were economic challenges, forgetfulness, and the feeling of wellness. Conclusion Adherence to medication is a major health problem among patients with schizophrenia and there is a need to improve adherence and treatment outcomes.
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18
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Greene M, Paladini L, Lemmer T, Piedade A, Touya M, Clark O. Systematic literature review on patterns of pharmacological treatment and adherence among patients with bipolar disorder type I in the USA. Neuropsychiatr Dis Treat 2018; 14:1545-1559. [PMID: 29950839 PMCID: PMC6011882 DOI: 10.2147/ndt.s166730] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Bipolar disorder type I (BD-I) is a chronic condition characterized by mania episodes followed by syndromic recovery periods, usually permeated by depressive symptoma-tology and recurring acute manic episodes. It requires long-term pharmacological treatment; thus, it is critical to understand the patterns of drug therapy use and medication compliance to better plan health care policies and needs. This systematic literature review aims to study these data among patients with BD-I in the USA, focusing on medications to treat mania. METHODS Articles published in the last 10 years to October 2016 were searched on MEDLINE and Embase. Studies on patterns of drug therapy, concordance of prescription with clinical practice guidelines, and adherence and persistence with pharmacological treatments for BD-I in the USA under observational conditions, with focus on treatments for mania, were selected. RESULTS Treatment prevalence for BD-I is low in the USA, with the most current study showing a 46% 12-month rate. There is a lack of studies addressing the use of long-acting injectable (LAI) antipsychotics. Second-generation antipsychotics (SGAs) have been used by nearly all patients receiving oral antipsychotics since the 2000s. However, 30%-60% of individuals with BD do not receive appropriate treatment, and adherence to oral therapies is poor, with medication possession ratios ≥80% seen in only approximately 60% of patients. For persistence rates, results suggest that treatment duration is short for a condition with recommendation for at least 6 months of maintenance therapy. Literature indicates that LAI SGAs may be related to better adherence and persistence. CONCLUSION There is a need for studies addressing specifically patterns of therapy and adherence to pharmacological treatment in BD-I patients in the USA to better understand the value of current standards, and an urgent need to improve the rates of adherence and persistence to BD-I pharmacotherapy and to increase the understanding of LAI SGAs' potential to address this issue.
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Affiliation(s)
- Mallik Greene
- Health Economics & Outcomes Research, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
| | | | | | | | - Maelys Touya
- Lundbeck Pharmaceuticals Services, LLC, Deerfield, IL, USA
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19
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Kreyenbuhl J, Record EJ, Palmer-Bacon J. A review of behavioral tailoring strategies for improving medication adherence in serious mental illness. DIALOGUES IN CLINICAL NEUROSCIENCE 2017. [PMID: 27489459 PMCID: PMC4969706 DOI: 10.31887/dcns.2016.18.2/jkreyenbuhl] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nonadherence to psychopharmacological treatments poses a significant challenge to treatment success in individuals with serious mental illness, with upwards of 60% of people not taking their psychiatric medications as prescribed. Nonadherence is associated with adverse outcomes, including exacerbation of psychiatric symptoms, impaired functioning, increased hospitalizations and emergency room use, and increased health care costs. Whereas interventions using psychoeducation or cognitive approaches, such as motivational interviewing, have largely proven ineffective in improving adherence, approaches employing behavioral tailoring that incorporate medication taking into the daily routine and/or use environmental supports have shown promise. Recently, adherence-enhancing behavioral tailoring interventions that utilize novel technologies, such as electronic monitors and mobile phones, have been developed. Although interventions utilizing these platforms have the potential for widespread dissemination to a broad range of individuals, most require further empirical testing. This paper reviews selected behavioral tailoring strategies that aim to improve medication adherence and other functional outcomes among individuals with serious mental illness.
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Affiliation(s)
- Julie Kreyenbuhl
- University of Maryland School of Medicine, Department of Psychiatry, Division of Psychiatric Services Research, Baltimore, Maryland, USA ; VA Capitol Healthcare Network (VISN 5) Mental lllness Research, Education, and Clinical Center (MIRECC), Baltimore, Maryland, USA
| | | | - Jessica Palmer-Bacon
- University of Maryland School of Medicine, Department of Psychiatry, Division of Psychiatric Services Research, Baltimore, Maryland, USA; University of Maryland School of edicine, Baltimore, Maryland, USA
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Chakrabarti S. Medication non-adherence in bipolar disorder: Review of rates, demographic and clinical predictors. World J Meta-Anal 2017; 5:103-123. [DOI: 10.13105/wjma.v5.i4.103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/24/2017] [Accepted: 06/13/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To conduct a systematic search for all studies examining rates and demographic and illness-related determinants of medication non-adherence in bipolar disorder (BD).
METHODS A comprehensive literature search was undertaken of six English-language databases to identify published articles on medication non-adherence in BD from inception till December 2016. Any article, either a review or an original-research article was examined for its relevance to the subject. All such articles were manually searched to locate any further articles containing relevant information. Studies were included only if they had adequately described the patient sample, assessment methods and statistical procedures, presented their results systematically and their conclusions were congruent with the results.
RESULTS The initial search yielded 249 articles on the subject; of these 198 articles were included. Of the 162 original-research studies, 132 had provided information on rates of medication non-adherence in BD. There was a wide variation in rates ranging from universal adherence (100%) to almost universal non-adherence (96%); this discrepancy was more due to methodological differences than true variations in rates. Notwithstanding the significant discrepancies in methodology, based on these 132 studies mean rates of 41.5%-43% and median rates of 40%-41% were obtained for medication non-adherence in BD. Rates of adherence with mood stabilizers were significantly lower than those for antipsychotics, or for medications of all classes. None of the demographic attributes were unequivocally linked to medication non-adherence in BD. Similarly, medication-related variables such as type of medications, doses, treatment regimens and side effects did not demonstrate consistent associations with non-adherence. Among clinical characteristics the presence of comorbid substance use disorder and absence of insight were the only two factors clearly linked to non-adherence in BD.
CONCLUSION Medication non-adherence is prevalent in about a third to half of patients with BD. Demographic, illness and treatment related factors do not predict non-adherence with certainty.
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Affiliation(s)
- Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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John RL, Antai-Otong D. Contemporary Treatment Approaches to Major Depression and Bipolar Disorders. Nurs Clin North Am 2017; 51:335-51. [PMID: 27229286 DOI: 10.1016/j.cnur.2016.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Mood disorders have a high incidence of coexisting psychiatric, substance use, and physical disorders. When these disorders are unrecognized and left untreated, patients are likely to have a reduced life expectancy and experience impaired functional and psychosocial deficits and poor quality of life. Psychiatric nurses are poised to address the needs of these patients through various approaches. Although the ideal approach for mood disorders continues to be researched, there is a compilation of data showing that integrated models of treatment that reflect person-centered, strength, and recovery-based principles produce positive clinical outcomes.
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Affiliation(s)
- Richard L John
- Department of Veterans Affairs-Greater Los Angeles, 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA.
| | - Deborah Antai-Otong
- Department of Veterans Affairs, Veterans Integrated Service Networks-(VISN-17), 2301 E. Lamar Boulevard, Arlington, TX 76006, USA
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Sajatovic M, Ng-Mak D, Solem CT, Lin FJ, Rajagopalan K, Loebel A. Dosing patterns and medication adherence in bipolar disorder patients treated with lurasidone: a US retrospective claims database analysis. Ther Adv Psychopharmacol 2016; 6:355-368. [PMID: 28008349 PMCID: PMC5167084 DOI: 10.1177/2045125316672135] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The aim of this study was to describe dosing patterns and medication adherence among bipolar patients who initiated lurasidone in a real-world setting. METHODS Adult bipolar patients who initiated lurasidone between 1 November 2010 and 31 December 2012 (index period) with 6-month pre- and post-index continuous enrollment were identified from the IMS RWD Adjudicated Claims US database. Patients were grouped by starting lurasidone daily dose: 20 mg (7.1%), 40 mg (62.2%), 60-80 mg (28.7%), and 120-160 mg (2.1%). Patient characteristics were compared across doses using Cochran-Armitage trend tests. Multivariable ordinal logistic regression assessed the association between initial lurasidone dose and patient characteristics. Medication adherence was measured using medication possession ratio (MPR). RESULTS Of 1114 adult bipolar patients (mean age 40.6 years, 70.6% female), 90% initiated lurasidone at 40 mg or 80 mg/day (mean 51.9 mg/day). Of these, 16.2% initiated lurasidone as monotherapy. Mean lurasidone maintenance dose was 55.2 mg/day and mean MPR was 0.53 [standard deviation (SD) = 0.34] over the 6-month follow up. Substance use, hyperglycemia, obesity, and prior antipsychotic use were associated with higher initial lurasidone doses (p < 0.05). Odds of a 20 mg/day increase in initial lurasidone dose was 1.6-times higher for patients with substance use [95% confidence interval (CI): 1.16-2.24], 2.6-times higher with hyperglycemia problems (95% CI: 1.15-5.83), 1.7-times higher with obesity (95% CI: 1.05-2.60), and 1.3 (95% CI: 1.01-1.78) and 1.8-times higher (95% CI: 1.17-2.86) with prior use of second- and first-generation antipsychotics, respectively. CONCLUSIONS This real-world analysis of bipolar patients indicated that 40 mg or 80 mg/day were the most common starting doses of lurasidone. A majority of patients used concomitant psychiatric medications (polypharmacy). Higher doses of lurasidone were prescribed to patients with comorbidities or prior antipsychotic use. Adherence to lurasidone was comparable to or better than antipsychotic adherence reported in bipolar disorder literature.
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Affiliation(s)
- Martha Sajatovic
- Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Daisy Ng-Mak
- Sunovion Pharmaceuticals Inc., Global Health Economics & Health Outcomes Research, 84 Waterford Drive, Marlborough, MA 01752, USA
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Community Health Workers: a Resource to Support Antipsychotic Medication Adherence. J Behav Health Serv Res 2016; 44:341-346. [DOI: 10.1007/s11414-016-9515-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Effects of Adherence to Statin Therapy on Health Care Outcomes and Utilizations in Taiwan: A Population-Based Study. BIOMED RESEARCH INTERNATIONAL 2015; 2015:149573. [PMID: 26539464 PMCID: PMC4619755 DOI: 10.1155/2015/149573] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 08/03/2015] [Accepted: 08/03/2015] [Indexed: 11/18/2022]
Abstract
Aim. Good medication adherence may decrease the probability of worse outcomes and reduce unnecessary medical care costs. This study aims to evaluate medication adherence for people on statin therapy. Methods. National health insurance databases were analyzed from January 1, 2001, to December 31, 2007. Study samples were patients of 45 years and older adults who took statin for the first time during the study period. Medication possession ratio (MPR) was measured until the patients had hospitalization or reached the three-year follow-up period. We identified a good (MPR ≥ 80%) and a poor (MPR < 80%) medication adherence group to conduct statistical analyses. Results. 40.8% of patients were of good medication adherence and 59.2% were of poor medication adherence. Multivariate logistic regression model indicated that the MPR ≥ 80% group had significantly less probability of hospitalization (P < 0.001). Being men, increasing age, higher Charlson Comorbidity Index (CCI) scores, seeking care mostly in the medical center or teaching hospitals, and living in the suburban or rural areas had higher probability of hospitalization (P < 0.05 or P < 0.001). The MPR ≥ 80% group spent less hospitalization expenditures (P < 0.001). Conclusion. Effective interventions may be applied to the poor medication adherence group in order to improve their health care outcomes.
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Cost-Effectiveness of Financial Incentives to Promote Adherence to Depot Antipsychotic Medication: Economic Evaluation of a Cluster-Randomised Controlled Trial. PLoS One 2015; 10:e0138816. [PMID: 26448540 PMCID: PMC4598185 DOI: 10.1371/journal.pone.0138816] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 08/26/2015] [Indexed: 12/20/2022] Open
Abstract
Background Offering a modest financial incentive to people with psychosis can promote adherence to depot antipsychotic medication, but the cost-effectiveness of this approach has not been examined. Methods Economic evaluation within a pragmatic cluster-randomised controlled trial. 141 patients under the care of 73 teams (clusters) were randomised to intervention or control; 138 patients with diagnoses of schizophrenia, schizo-affective disorder or bipolar disorder participated. Intervention participants received £15 per depot injection over 12 months, additional to usual acute, mental and community primary health services. The control group received usual health services. Main outcome measures: incremental cost per 20% increase in adherence to depot antipsychotic medication; incremental cost of ‘good’ adherence (defined as taking at least 95% of the prescribed number of depot medications over the intervention period). Findings Economic and outcome data for baseline and 12-month follow-up were available for 117 participants. The adjusted difference in adherence between groups was 12.2% (73.4% control vs. 85.6% intervention); the adjusted costs difference was £598 (95% CI -£4 533, £5 730). The extra cost per patient to increase adherence to depot medications by 20% was £982 (95% CI -£8 020, £14 000). The extra cost per patient of achieving 'good' adherence was £2 950 (CI -£19 400, £27 800). Probability of cost-effectiveness exceeded 97.5% at willingness-to-pay values of £14 000 for a 20% increase in adherence and £27 800 for good adherence. Interpretation Offering a modest financial incentive to people with psychosis is cost-effective in promoting adherence to depot antipsychotic medication. Direct healthcare costs (including costs of the financial incentive) are unlikely to be increased by this intervention. Trial Registration ISRCTN.com 77769281
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McCormick U, Murray B, McNew B. Diagnosis and treatment of patients with bipolar disorder: A review for advanced practice nurses. J Am Assoc Nurse Pract 2015; 27:530-42. [PMID: 26172568 PMCID: PMC5034840 DOI: 10.1002/2327-6924.12275] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 04/01/2015] [Indexed: 12/19/2022]
Abstract
Purpose This review article provides an overview of the frequency, burden of illness, diagnosis, and treatment of bipolar disorder (BD) from the perspective of the advanced practice nurses (APNs). Data sources PubMed searches were conducted using the following keywords: “bipolar disorder and primary care,” restricted to dates 2000 to present; “bipolar disorder and nurse practitioner”; and “bipolar disorder and clinical nurse specialist.” Selected articles were relevant to adult outpatient care in the United States, with a prioritization of articles written by APNs or published in nursing journals. Conclusions BD has a substantial lifetime prevalence in the population at 4%. Because the manic or depressive symptoms of BD tend to be severe and recurrent over a patient's lifetime, the condition is associated with significant burden to the individual, caregivers, and society. Clinician awareness that BD may be present increases the likelihood of successful recognition and appropriate treatment. A number of pharmacological and nonpharmacological treatments are available for acute and maintenance treatments, with the prospect of achieving reduced symptom burden and increased functioning for many patients. Implications for practice Awareness of the disease burden, diagnostic issues, and management choices in BD has the potential to enhance outcome in substantial proportions of patients.
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Affiliation(s)
| | | | - Brittany McNew
- Medical Services, Centerstone of Indiana, Bloomington, Indiana
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Jann MW. Diagnosis and treatment of bipolar disorders in adults: a review of the evidence on pharmacologic treatments. AMERICAN HEALTH & DRUG BENEFITS 2014; 7:489-99. [PMID: 25610528 PMCID: PMC4296286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 11/25/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Patients with bipolar disorder are exceptionally challenging to manage because of the dynamic, chronic, and fluctuating nature of their disease. Typically, the symptoms of bipolar disorder first appear in adolescence or early adulthood, and are repeated over the patient's lifetime, expressed as unpredictable recurrences of hypomanic/manic or depressive episodes. The lifetime prevalence of bipolar disorder in adults is reported to be approximately 4%, and its management was estimated to cost the US healthcare system in 2009 $150 billion in combined direct and indirect costs. OBJECTIVE To review the published literature and describe the personal and societal burdens associated with bipolar disorder, the impact of delays in accurate diagnosis, and the evidence for the clinical effectiveness of available pharmacologic therapies. METHODS The studies in this comprehensive review were selected for inclusion based on clinical relevance, importance, and robustness of data related to diagnosis and treatment of bipolar disorder. The search terms that were initially used on MEDLINE/PubMed and Google Scholar were restricted to 1994 through 2014 and included "bipolar disorder," "mania," "bipolar depression," "mood stabilizer," "atypical antipsychotics," and "antidepressants." High-quality, recent reviews of major relevant topics were included to supplement the primary studies. DISCUSSION Substantial challenges facing patients with bipolar disorder, in addition to their severe mood symptoms, include frequent incidence of psychiatric (eg, anxiety disorders, alcohol or drug dependence) and general medical comorbidities (eg, diabetes, cardiovascular disease, obesity, migraine, and hepatitis C virus infection). It has been reported that more than 75% of patients take their medication less than 75% of the time, and the rate of suicide (0.4%) among patients with bipolar disorder is more than 20 times greater than in the general US population. Mood stabilizers are the cornerstone of treatment of bipolar disorder, but atypical antipsychotics are broadly as effective; however, differences in efficacy exist between individual agents in the treatment of the various phases of bipolar disorder, including treatment of acute mania or acute depression symptoms, and in the prevention of relapse. CONCLUSION The challenges involved in managing bipolar disorder over a patient's lifetime are the result of the dynamic, chronic, and fluctuating nature of this disease. Diligent selection of a treatment that takes into account its efficacy in the various phases of the disorder, along with the safety profile identified in clinical trials and in the real world can help ameliorate the impact of this devastating condition.
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Affiliation(s)
- Michael W Jann
- Dr Jann is Professor and Chair, Department of Pharmacotherapy, University of North Texas System College of Pharmacy, University of North Texas Health Sciences Center, Fort Worth, TX
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A 2-year follow-up study of discharged psychiatric patients with bipolar disorder. Psychiatry Res 2014; 218:75-8. [PMID: 24794029 DOI: 10.1016/j.psychres.2014.04.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 03/31/2014] [Accepted: 04/09/2014] [Indexed: 02/06/2023]
Abstract
This study investigated medication compliance, disease recurrence and the recovery of social function in discharged psychiatric patients with bipolar disorder. A 2-year follow-up was conducted on all patients with bipolar disorder, who were hospitalized in our psychiatric department between June 2010 and May 2011. Risk factors for recurrence were analyzed based on a self-designed questionnaire. Of the 252 patients in the study, 210 had complete information (83.3%) for the 2-year follow-up: 170 cases of bipolar I disorder and 40 cases of bipolar II disorder. The 1-year and 2-year full-compliance rates were 41.0% and 35.7%, respectively. The 1-year and 2-year recurrence rates were 42.4% and 61.0%, respectively. Statistically significant differences in rates were found between the bipolar subtypes for 1-year full compliance, 1-year non-compliance, 2-year recurrence, and 2-year readmission. Logistic regression identified different sets of independent variables that were risk factors for recurrence, and protective factors for recurrence at 1 year and 2 years after hospital discharge. The results of the follow-up indicated that the situation of patients with bipolar disorder after discharge is not optimistic, because of high recurrence rates, high non-compliance rates and low recovery rates. Clinical and social experts should pay more attention to the situation.
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Col SE, Caykoylu A, Karakas Ugurlu G, Ugurlu M. Factors affecting treatment compliance in patients with bipolar I disorder during prophylaxis: a study from Turkey. Gen Hosp Psychiatry 2014; 36:208-13. [PMID: 24359677 DOI: 10.1016/j.genhosppsych.2013.11.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 11/20/2013] [Accepted: 11/20/2013] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Treatment noncompliance is one of the most frequent causes of relapse and recurrence in patients with bipolar I disorder. Treatment compliance among patients with bipolar disorder is affected by individual patients' features, the disease itself, doctor-patient relationships and patients' socio-economic and cultural characteristics. This study aimed to determine the factors affecting treatment compliance during the treatment of bipolar disorder and contribute to current clinical strategies. METHODS Data were collected from 78 volunteers with bipolar I disorder in remission; all volunteers were being treated solely with mood stabilisers. Sociodemographic and clinical data were gathered through a semi-structured interview designed by researchers. The Hamilton Depression Rating Scale and the Young Mania Rating Scale were both administered to assess remission of bipolar I disorder, and a self-report scale, the Medication Adherence Rating Scale, was administered to assess medication adherence. RESULTS Treatment compliant patients reported that they had received adequate social support and had been sufficiently informed by their physicians about the illness and treatment. Treatment compliant individuals with higher rates of hospitalisations and the results indicate that the number of depressive episodes adversely affects treatment compliance. There was not a statistically significant difference in treatment compliance based on duration of illness, euthymia, time, total number of episodes, age of onset, predominant polarity, drug doses, number of daily medications, frequency of daily medications, or type of mood stabiliser used. CONCLUSIONS These results indicate that there are differences between compliant and non-compliant bipolar I disorder patients in terms of adequate social support, information provided by the physician about the illness and treatment, number of depressive episodes and number of hospitalisations.
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Affiliation(s)
- Saime Esra Col
- Deparment of Psychiatry, Igdır State Hospital, Igdır, Turkey.
| | - Ali Caykoylu
- Department of Psychiatry, Yıldırım Beyazıt University Faculty of Medicine, Ankara Ataturk Training and Research Hospital, Ankara, Turkey.
| | - Gorkem Karakas Ugurlu
- Department of Psychiatry, Yıldırım Beyazıt University Faculty of Medicine, Ankara Ataturk Training and Research Hospital, Ankara, Turkey.
| | - Mustafa Ugurlu
- Department of Psychiatry, Yıldırım Beyazıt University Faculty of Medicine, Ankara Ataturk Training and Research Hospital, Ankara, Turkey.
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Sajatovic M, Tatsuoka C, Dines P, Bialko CS, Athey M, Williams T, Cassidy KA. Patient choice as a driver of medication-switching in non-adherent individuals with bipolar disorder. Patient Prefer Adherence 2014; 8:487-91. [PMID: 24790416 PMCID: PMC4000249 DOI: 10.2147/ppa.s56790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Psychotropic-related weight gain is a common concern among patients with bipolar disorder (BD). This concern affects satisfaction with treatment and may lead to non-adherence and relapse. This was a 12-week, uncontrolled prospective trial of patient-choice-facilitated ziprasidone switching among non-adherent BD patients with weight concerns. This study was conducted from January 2011 to July 2012. METHOD Patients were asked to identify the "offending" BD medication which they believed was causing weight problems, and this agent was replaced with ziprasidone. The primary outcome was change in adherence as measured with the Tablets Routine Questionnaire (TRQ). Secondary outcomes included medication attitudes, BD symptoms, global psychopathology, social functioning, and quality of life. RESULTS The most common agents causing weight concerns were quetiapine (N=7, 23%), aripiprazole (N=4, 13%), olanzapine, lithium, and divalproex (all N=3, 10%). Adherence improved from a baseline of missing 48.6% of prescribed BD medication in the past week (44.9% in the past month) to missing 25.3% (P=0.002) of prescribed BD medication in the past week (P<0.001, in the past month) at endpoint. Medication attitudes, symptoms, functioning, and quality of life improved but there were no differences in body weight. CONCLUSION While findings must be tempered by methodological limitations such as small sample and uncontrolled design, patient-facilitated medication-switching appeared to improve adherence and BD outcomes in these non-adherent individuals. Additional studies involving patient-facilitated medication-switching and shared decision-making in BD are needed.
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Affiliation(s)
- Martha Sajatovic
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
- Department of Neurology, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
- Correspondence: Martha Sajatovic, Department of Psychiatry, University, Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, USA, Tel +1 216 844 2808, Fax +1 216 844 2742, Email
| | - Curtis Tatsuoka
- Department of Neurology, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Philipp Dines
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Christopher S Bialko
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Melanie Athey
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Tiffany Williams
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Kristin A Cassidy
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
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Fung V, Price M, Busch AB, Landrum MB, Fireman B, Nierenberg A, Dow WH, Hui R, Frank R, Newhouse JP, Hsu J. Adverse clinical events among medicare beneficiaries using antipsychotic drugs: linking health insurance benefits and clinical needs. Med Care 2013; 51:614-21. [PMID: 23752219 PMCID: PMC3687515 DOI: 10.1097/mlr.0b013e31829019c5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Medicare Part D provides formulary protections for antipsychotics but does not exempt these drugs from cost-sharing. We investigated the impact of Part D coverage on antipsychotic drug spending, adherence, and clinical outcomes among beneficiaries with varying indications for use. METHODS We conducted a historical cohort study of Medicare Advantage beneficiaries who received antipsychotic drugs, with diagnoses of schizophrenia or bipolar disorder or with no mental health diagnoses (N=10,190). Half had a coverage gap; half had no gap because of low-income subsidies. Using fixed effects regression models, we examined changes in spending and adherence as beneficiaries experienced cost-sharing increases after reaching the gap. We examined changes in hospitalizations and emergency department visits using proportional hazard models. RESULTS Across all diagnostic groups, total monthly expenditure on antipsychotic drugs decreased with cost-sharing increases in the gap compared with those with no gap (eg, schizophrenia: -$123 95% confidence interval [-$138, -$108]), and out-of-pocket spending increased (eg, schizophrenia: $104 [$98, $110]). Adherence similarly decreased, with the largest declines among those with schizophrenia (-20.6 percentage points [-22.3, -18.9] in proportion of days covered). Among beneficiaries with schizophrenia and bipolar disorder, hospitalizations and emergency department visit rates increased with cost-sharing increases (eg, schizophrenia: hazard ratio=1.32 [1.06, 1.65] for all hospitalizations), but did not among subjects without mental health diagnoses. Clinical event rates did not change among beneficiaries with low-income subsidies without gaps. CONCLUSIONS There is evidence of interruptions in antipsychotic use attributable to Part D cost-sharing. Adverse events increased among beneficiaries with approved indications for use, but not among beneficiaries without such indications.
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Affiliation(s)
- Vicki Fung
- Mid-Atlantic Permanente Research Institute, Mid-Atlantic Permanente Medical Group, Rockville, MD, USA.
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Killaspy H, Zis P. Predictors of outcomes for users of mental health rehabilitation services: a 5-year retrospective cohort study in inner London, UK. Soc Psychiatry Psychiatr Epidemiol 2013; 48:1005-12. [PMID: 22945367 DOI: 10.1007/s00127-012-0576-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 08/23/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE There have been few recent studies reporting on the outcomes for users of psychiatric rehabilitation services. This group has complex, longer-term mental health problems. We aimed to investigate 5-year outcomes for this group and identify factors associated with outcome. METHOD Clinical outcome data on 141 users of a mental health rehabilitation service in inner London, UK, surveyed in 2005, were collected retrospectively 5 years later. Positive outcome was defined for those who were inpatients in 2005 as achieving and sustaining community discharge, and for those who were community patients, as progressing to and sustaining a less supported community placement. Negative outcome was defined as remaining in the same placement, moving to more supported placement or having a psychiatric admission. RESULTS Over 5 years, 17 (12 %) people died, 50 (40 %) had a positive outcome, 33 (27 %) remained in a placement with a similar level of support and 41 (38 %) moved to a more supported placement and/or had a psychiatric admission. Thirteen (10 %) people moved to independent accommodation and sustained their tenancy successfully. Those with a record of non-adherence with medication during the 5 years were more likely to have a negative outcome (OR 8.60, 95 % CI 3.41 to 21.70). CONCLUSION Adherence to medication is an important factor in facilitating successful community discharge for people with complex mental health problems who require psychiatric rehabilitation.
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Affiliation(s)
- Helen Killaspy
- Mental Health Sciences Unit, University College London, Charles Bell House, 67-73 Riding House Street, London, W1W 7EJ, UK.
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Association between therapeutic alliance, care satisfaction, and pharmacological adherence in bipolar disorder. J Clin Psychopharmacol 2013; 33:343-50. [PMID: 23609394 PMCID: PMC3873324 DOI: 10.1097/jcp.0b013e3182900c6f] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES We sought to understand the association of specific aspects of care satisfaction, such as patients' perceived relationship with their psychiatrist and access to their psychiatrist and staff, and therapeutic alliance with participants' likelihood to adhere to their medication regimens among patients with bipolar disorder. METHODS We examined data from the multicenter Systematic Treatment Enhancement Program for Bipolar Disorder, an effectiveness study investigating the course and treatment of bipolar disorder. We expected that participants (n = 3037) with positive perceptions of their relationship with their psychiatrist and quality of psychopharmacologic care, as assessed by the Helping Alliance Questionnaire and Care Satisfaction Questionnaire, would be associated with better medication adherence. We utilized logistic regression models controlling for already established factors associated with poor adherence. RESULTS Patients' perceptions of collaboration, empathy, and accessibility were significantly associated with adherence to treatment in individuals with bipolar disorder completing at least 1 assessment. Patients' perceptions of their psychiatrists' experience, as well as of their degree of discussing medication risks and benefits, were not associated with medication adherence. CONCLUSIONS Patients' perceived therapeutic alliance and treatment environment impact their adherence to pharmacotherapy recommendations. This study may enable psychopharmacologists' practices to be structured to maximize features associated with greater medication adherence.
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Gibson S, Brand SL, Burt S, Boden ZVR, Benson O. Understanding treatment non-adherence in schizophrenia and bipolar disorder: a survey of what service users do and why. BMC Psychiatry 2013; 13:153. [PMID: 23714262 PMCID: PMC3695802 DOI: 10.1186/1471-244x-13-153] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 05/13/2013] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Approximately half of service users with schizophrenia or bipolar disorder do not fully follow treatment recommendations. Studies of adherence have not adequately explored the frequency, consequences and meanings of non-adherence behaviours from service users' perspectives. This study contributes to a more fine-grained understanding of treatment choices and the support service users require in order to maximise benefit from their medications. METHODS This was a mixed-methods questionnaire study, employing quantitative and thematic qualitative analyses. Thirty-five individuals with a diagnosis of, and receiving psycho-pharmaceutical treatment for, schizophrenia or bipolar disorder answered online or telephone questions about whether, how, and why they deviated from their treatment recommendations, and what support they currently and would like to receive. RESULTS Over half of participants identified themselves as being non-adherent, however when asked in detail about intentional and unintentional adherence, 77% reported deviating from treatment recommendations. Critically, 29% were non-adherent and satisfied with being so. Service users' satisfaction with their support was positively correlated with satisfaction with their medication. Participants' made treatment choices in order to live well. Both side-effects and symptoms could be obstacles to adherence, but feeling well also impacted on participants' treatment choices. Treatment choices were often made in the context of living well day-to-day, and did not necessarily take into account longer-term effects of non-adherence. Participants wanted more information about their medications, better emotional support (including better access to psychological therapies) and stability in their relationships with health professionals. CONCLUSIONS This study suggests that non-adherence, both intentional and unintentional, is common amongst individuals with diagnoses of schizophrenia and bipolar disorder, and that this often occurs without health professionals' knowledge or support. Treatment choices reflect a desire to live well, but are often driven by short-term needs. Given access to more information, and importantly to emotional support, service users could be helped to make treatment choices that adequately reflect the long-term risks of non-adherence, as well as allowing them to live well day-to-day. More research is required better to understand the meanings and complexities of service users' treatment choices.
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Affiliation(s)
- Susanne Gibson
- SANE mental health charity, 40 Adler Street, London, UK.
| | - Sarah L Brand
- European Centre for Environment and Human Health, Medical School, University of Exeter, Exeter, UK
| | - Sarah Burt
- SANE mental health charity, 40 Adler Street, London, UK
| | - Zoë V R Boden
- SANE mental health charity, 40 Adler Street, London, UK
| | - Outi Benson
- SANE mental health charity, 40 Adler Street, London, UK
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Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Beaulieu S, Alda M, O'Donovan C, Macqueen G, McIntyre RS, Sharma V, Ravindran A, Young LT, Milev R, Bond DJ, Frey BN, Goldstein BI, Lafer B, Birmaher B, Ha K, Nolen WA, Berk M. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar Disord 2013; 15:1-44. [PMID: 23237061 DOI: 10.1111/bdi.12025] [Citation(s) in RCA: 540] [Impact Index Per Article: 49.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The Canadian Network for Mood and Anxiety Treatments published guidelines for the management of bipolar disorder in 2005, with updates in 2007 and 2009. This third update, in conjunction with the International Society for Bipolar Disorders, reviews new evidence and is designed to be used in conjunction with the previous publications.The recommendations for the management of acute mania remain largely unchanged. Lithium, valproate, and several atypical antipsychotic agents continue to be first-line treatments for acute mania. Monotherapy with asenapine, paliperidone extended release (ER), and divalproex ER, as well as adjunctive asenapine, have been added as first-line options.For the management of bipolar depression, lithium, lamotrigine, and quetiapine monotherapy, as well as olanzapine plus selective serotonin reuptake inhibitor (SSRI), and lithium or divalproex plus SSRI/bupropion remain first-line options. Lurasidone monotherapy and the combination of lurasidone or lamotrigine plus lithium or divalproex have been added as a second-line options. Ziprasidone alone or as adjunctive therapy, and adjunctive levetiracetam have been added as not-recommended options for the treatment of bipolar depression. Lithium, lamotrigine, valproate, olanzapine, quetiapine, aripiprazole, risperidone long-acting injection, and adjunctive ziprasidone continue to be first-line options for maintenance treatment of bipolar disorder. Asenapine alone or as adjunctive therapy have been added as third-line options.
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Affiliation(s)
- Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
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Vieta E, Azorin JM, Bauer M, Frangou S, Perugi G, Martinez G, Schreiner A. Psychiatrists' perceptions of potential reasons for non- and partial adherence to medication: results of a survey in bipolar disorder from eight European countries. J Affect Disord 2012; 143:125-30. [PMID: 22840608 DOI: 10.1016/j.jad.2012.05.041] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 05/16/2012] [Accepted: 05/16/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND Partial/non-adherence to medication by patients with bipolar disorder is associated with exacerbation of symptoms, neurocognitive decline and increased risk of suicide and has a major influence on patient outcomes. Understanding psychiatrists' views on the causes and management of non-adherence are vital to address adherence problems effectively. METHODS A 15-question survey was conducted of 2448 psychiatrists treating patients with bipolar disorder in eight European countries to ascertain their perceptions of the level and causes of non-adherence, and their preferred methods by which to assess it. RESULTS A majority of patients (57%) were estimated to be partially/non-adherent. Three in four psychiatrists responded that most patients who deteriorated after stopping medication were unable to attribute this to non-adherence. An irregular daily routine/living circumstance affecting adherence was considered the most important reason for patients discontinuing medication. Only 4% of psychiatrists deemed intolerable side effects had led to most patients stopping their medication; 11% responded that drug/alcohol consumption may have impacted on adherence to medication for the majority of patients. LIMITATIONS The survey was not distributed to all psychiatrists in the countries and the impact on the results, of any difference in the demographics of the respondents with respect to the population of psychiatrists across the eight countries, is not known. CONCLUSIONS Partial/non-adherence remains a considerable problem amongst patients with bipolar disorder. There is a need for increased knowledge concerning partial/non-adherence at the level of the clinician-patient interaction, to reduce its impact and bring about improved clinical outcomes.
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Affiliation(s)
- Eduard Vieta
- Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, ENBREC, 08036 Barcelona, Spain.
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Buck HG, Meghani S, Bettger JP, Byun E, Fachko MJ, O'Connor M, Tocchi C, Naylor M. The use of comorbidities among adults experiencing care transitions: a systematic review and evolutionary analysis of empirical literature. Chronic Illn 2012; 8:278-95. [PMID: 22514061 DOI: 10.1177/1742395312444741] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To systematically review how comorbidities are employed in the empirical literature for adults coping with multiple chronic conditions during common episodes of acute illness that resulted in transition across health care setting. METHODS Evolutionary concept analysis inductively identifies current consensus regarding the usage of a concept and results in exploring attributes and clarification of the concept. Sixty studies from 1965 to 2009 identified from MEDLINE, CINAHL, PsychINFO, and ISI Web of Science databases were analysed. RESULTS Comorbidities were used heterogeneously among reviewed studies with most controlling for their presence (n=33) and lacking robust measurement (n=37). The designation of index or principal condition was equally heterogeneous with approximately half (n=26) representing the main disease or diagnosis of interest to the researcher. In this study comorbidities were associated with personal, disease or system level antecedents and consequences. A conceptual framework is proposed. DISCUSSION The impact of comorbidities on the care and outcomes of adults coping with multiple chronic conditions is limited by heterogeneous and ambiguous usage. While analytic techniques have become more sophisticated, continued lack of meaningful conceptualization and instrument use has limited maturation of this important concept for research, practice and policy purposes.
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Affiliation(s)
- Harleah G Buck
- School of Nursing, The Pennsylvania State University, University Park, Philadelphia, 16802, USA.
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Berger A, Edelsberg J, Sanders KN, Alvir JMJ, Mychaskiw MA, Oster G. Medication adherence and utilization in patients with schizophrenia or bipolar disorder receiving aripiprazole, quetiapine, or ziprasidone at hospital discharge: a retrospective cohort study. BMC Psychiatry 2012; 12:99. [PMID: 22856540 PMCID: PMC3480886 DOI: 10.1186/1471-244x-12-99] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 07/11/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Schizophrenia and bipolar disorder are chronic debilitating disorders that are often treated with second-generation antipsychotic agents, such as aripiprazole, quetiapine, and ziprasidone. While patients who are hospitalized for schizophrenia and bipolar disorder often receive these agents at discharge, comparatively little information exists on subsequent patterns of pharmacotherapy. METHODS Using a database linking hospital admission records to health insurance claims, we identified all patients hospitalized for schizophrenia (ICD-9-CM diagnosis code 295.XX) or bipolar disorder (296.0, 296.1, 296.4-296.89) between January 1, 2001 and September 30, 2008 who received aripiprazole, quetiapine, or ziprasidone at discharge. Patients not continuously enrolled for 6 months before and after hospitalization ("pre-admission" and "follow-up", respectively) were excluded. We examined patterns of use of these agents during follow-up, including adherence with treatment (using medication possession ratios [MPRs] and cumulative medication gaps [CMGs]) and therapy switching. Analyses were undertaken separately for patients with schizophrenia and bipolar disorder, respectively. RESULTS We identified a total of 43 patients with schizophrenia, and 84 patients with bipolar disorder. During the 6-month period following hospitalization, patients with schizophrenia received an average of 101 therapy-days with the second-generation antipsychotic agent prescribed at discharge; for patients with bipolar disorder, the corresponding value was 68 therapy-days. Mean MPR at 6 months was 55.1% for schizophrenia patients, and 37.3% for those with bipolar disorder; approximately one-quarter of patients switched to another agent over this period. CONCLUSIONS Medication compliance is poor in patients with schizophrenia or bipolar disorder who initiate treatment with aripiprazole, quetiapine, or ziprasidone at hospital discharge.
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Affiliation(s)
- Ariel Berger
- Policy Analysis Inc. (PAI), Four Davis Court, Brookline, MA 02445, USA.
| | - John Edelsberg
- Policy Analysis Inc. (PAI), Four Davis Court, Brookline, Massachusetts, 02445, USA
| | | | | | | | - Gerry Oster
- Policy Analysis Inc. (PAI), Four Davis Court, Brookline, Massachusetts, 02445, USA
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Bagalman E, Muser E, Choi JC, Durden E, Macfadden W, Haskins JT, Dirani R. Health care resource utilization and costs in a commercially insured population of patients with bipolar disorder type I and frequent psychiatric interventions. Clin Ther 2011; 33:1381-1390.e4. [PMID: 22000656 DOI: 10.1016/j.clinthera.2011.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND Bipolar disorder type I (BP-I) is one of the most expensive behavioral diagnoses in the United States. Characterizing patient populations that consume significant resources would be useful for designing and implementing additional resources and targeted interventions to reduce the costs of BP-I. OBJECTIVE This analysis compared the characteristics, health care resource utilization, and costs of commercially insured patients with BP-I (indicating a history of manic or mixed episodes) and frequent psychiatric interventions (FPIs) versus those without FPIs. METHODS This retrospective study used data from commercial insurance claims to identify adults with FPIs (≥2 clinically significant events [CSEs]) or without FPIs during a 12-month identification period (year 1). CSEs included emergency department (ED) visits or hospitalizations with a principal diagnosis of BP-I, the addition of a new medication to the observed treatment regimen, or a ≥50% increase in BP-I medication dose. Demographic and clinical characteristics were evaluated during the identification period, and health care resource utilization and costs were evaluated during a 12-month follow-up period (year 2). RESULTS Data from 7620 patients with FPIs and 11,571 without FPIs were included (women, 67.1% and 59.9%, respectively; P < 0.001). Of patients with FPIs in the identification period, 22.2% continued to have FPIs in the follow-up period. In the follow-up period, the group with FPIs had a greater proportion of patients with psychiatric-related inpatient hospitalizations (14.6% vs 2.8%) and ED visits (11.6% vs 2.7%) [corrected], a longer mean hospital length of stay (11.74% vs 8.24 days) [corrected], and greater adjusted mean psychiatric-related costs ($6617 vs $3276) and all-cause health care costs ($14,091 vs $9357) compared with the group without FPIs (all, P < 0.001). The risks for a psychiatric-related hospitalization and an ED visit during the follow-up period were significantly greater in the group with FPIs compared with the group without (odds ratios, 4.86 and 3.76, respectively; both, P < 0.01). CONCLUSIONS In this retrospective analysis, FPIs were associated with a greater number of FPIs during follow-up, ∼2-fold the psychiatric-related costs, and 1.5-fold the all-cause health care costs compared with no FPIs. These data highlight the economic burden of FPIs and the potential for health care cost reductions from improved management options in these patients.
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Rabenda V, Reginster JY. Overcoming problems with adherence to osteoporosis medication. Expert Rev Pharmacoecon Outcomes Res 2011; 10:677-89. [PMID: 21155701 DOI: 10.1586/erp.10.76] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Nonadherence to pharmacological treatment in osteoporosis is a well-recognized problem. As in other chronic diseases, adherence to osteoporosis treatment is poor, resulting in enormous burden on patients and healthcare resources. Most importantly, low adherence rates consistently result in increased rates of fractures. However, it seems that efforts to evaluate and improve rates of both compliance and persistence are increasing. The extension of dosing intervals may be an element, among others, allowing improvements in therapeutic adherence. Improved patient education, enhancing healthcare provider-patients interaction, taking into account patient's preferences and involving them in treatment decisions may improve adherence.
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Affiliation(s)
- Véronique Rabenda
- Department of Public Health, Epidemiology and Health Economics, CHU-Bât. B23, 4000 Liège, Belgium.
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Patel UB, Ni Q, Clayton C, Lam P, Parks J. An attempt to improve antipsychotic medication adherence by feedback of medication possession ratio scores to prescribers. Popul Health Manag 2011; 13:269-74. [PMID: 20879908 DOI: 10.1089/pop.2009.0053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Poor medication adherence is well documented for patients with severe and persistent mental illness. The State of Missouri implemented an early alert system to notify caregivers when patients fail to refill essential prescriptions in a timely manner and as an educational resource for providers on best practices for improving treatment adherence. Missouri Medicaid patients who were prescribed at least 1 of 9 orally-administered antipsychotic medications and who had at least 1 medication possession ratio (MPR) score below 0.8 were included in the adherence intervention group. Their prescribing clinicians and case managers were messaged electronically 2 times per week at the point that failure to refill the targeted prescription was identified. Notification occurred when the prescription had lapsed at 7 days, 30 days, and 45 days, and occurred in real time. In addition, MPR scores were provided monthly for the most recent 6-month period. Change in MPR scores was measured for the intervention group and for a matched control group. Trends in MPR scores were analyzed for both groups pre, during, and post intervention. In both the intervention and postintervention periods, there was a significant difference in the MPR scores between the two groups. The intervention group had a significantly greater increase in MPR score between preintervention and intervention periods. After the conclusion of the intervention, the MPR score decreased somewhat but was still higher than during the preintervention period. Results suggest that clinicians and patients need specific data about adherence in order to address the issue.
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Affiliation(s)
- Urvashi B Patel
- Outcomes Research Division, Caremanagement Technologies , White Plains, NY 10605, USA.
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Lang K, Korn J, Muser E, Choi JC, Abouzaid S, Menzin J. Predictors of medication nonadherence and hospitalization in Medicaid patients with bipolar I disorder given long-acting or oral antipsychotics. J Med Econ 2011; 14:217-26. [PMID: 21370989 DOI: 10.3111/13696998.2011.562265] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To assess rates and predictors of medication nonadherence and hospitalization among patients with bipolar I disorder. METHODS This was a retrospective cohort analysis of Medicaid patients who were aged ≥ 18 years, had ≥ 1 inpatient or ≥ 2 outpatient medical claims indicating bipolar I disorder (ICD-9-CM codes 296.0x-296.1x, 296.4x-296.7x), and filled ≥ 1 prescription for antipsychotic medication between January 1, 2004, and December 31, 2006. Patients were followed for 1 year from the date of first (index) antipsychotic prescription. Patients were required to be continuously eligible for Medicaid without dual Medicare eligibility from 1 year before (baseline) through 1 year after (follow-up) index, and were required to receive ≥ 1 additional antipsychotic during follow-up. Descriptive statistics and predictors of medication nonadherence (medication possession ratio <0.8) and hospitalization were generated. RESULTS A total of 9410 patients met study eligibility criteria with a mean age of 38 years; 74% were female and 75% were white. Approximately 31% and 57% had baseline diagnoses of substance abuse and other psychiatric conditions, respectively. During follow-up, roughly 60% of patients were nonadherent and 40% of patients were hospitalized for any reason (37% psychiatric-related). Multivariate analysis showed that new antipsychotic starts, younger patients, those with a baseline concomitant substance abuse diagnosis, those taking a baseline antidepressant, and those with a baseline psychiatric hospitalization had significantly higher risk of nonadherence. Baseline psychiatric hospitalization, baseline substance abuse or other psychosis diagnosis, baseline use of an anxiolytic, anticholinergic, or anticonvulsant, and nonadherence to therapy in the follow-up period were significant predictors of increased risk of hospitalization. LIMITATIONS This analysis did not attempt to evaluate the complex relationships among treatment type, adherence, hospitalization, and other variables. CONCLUSIONS Study results showed that the risk of nonadherence is relatively high and confirmed that nonadherence is associated with a greater risk of hospitalization.
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Barraco A, Rossi A, Nicolò G. Description of study population and analysis of factors influencing adherence in the observational Italian study "Evaluation of Pharmacotherapy Adherence in Bipolar Disorder" (EPHAR). CNS Neurosci Ther 2010; 18:110-8. [PMID: 21199448 DOI: 10.1111/j.1755-5949.2010.00225.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In patients with bipolar disorder, medication is effective in preventing relapses. Unfortunately, adherence to treatment in bipolar disorder, as in other chronic or recurrent conditions, is not optimal. Estimates of nonadherence to prescribed treatment range from 30% to 60% in epidemiological studies, and are at around 30% in clinical trials. Adherence to treatment is a potent predictor of effectiveness, both in clinical trials and cohort studies, therefore is a very relevant area of investigation. This study will try to show a picture of the real life care where adherence is influenced by a wide range of variables. METHODS Prospective, observational, multicenter study in 650 adult patients with bipolar disorder, who had to initiate or change their treatment regimen, observed for 1 year. Adherence was measured by the Simplified Medication Adherence Questionnaire (SMAQ). Additional variables: Symptom severity, Montgomery-Åsberg Depression Rating Scale (MADRS), Young Mania Rating Scale (YMRS), Clinical Global Impression-Bipolar Disorder (CGI-BD), the Drug Attitude Inventory score (DAI-30), and quality of life (EuroQoL 5 Dimensions). The variables were recorded every 3 months for the next year. RESULTS Most subjects were out-patients (77.1%), female (58.8%), aged 31-50 years (50.1%) and overweight (41.8%) or obese (28.7%); 67.4% had type I bipolar disorder and 66.8% had depressive or mixed symptoms. Adherence was 39.9% at baseline (and increased up to 67.0% at completion. The main predictors of nonadherence were alcohol consumption, severe bipolar symptoms, young age at time of first treatment, negative attitude towards treatment. CONCLUSIONS The patient population of this observational trial was representative of the patients changing their therapy for bipolar disorder seen in clinical practice in Italy. Lack of adherence to pharmacotherapy for bipolar disorder is a serious issue, which is more likely to arise in alcohol users and patients with severe symptoms, negative attitude towards medication and/or initiation of treatment early in life. The findings could lead to a more adequate approach of adherence in patients with bipolar disorders.
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Affiliation(s)
- Alessandra Barraco
- Medical Department, Eli Lilly Italia S.p.A., Sesto Fiorentino, Florence, Rome, Italy
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Tang CH, Hsieh MH, Hung ST, Lee IH, Lin YJ, Yang YK. One-year post-hospital medical costs and relapse rates of bipolar disorder patients in Taiwan: a population-based study. Bipolar Disord 2010; 12:859-65. [PMID: 21176033 DOI: 10.1111/j.1399-5618.2010.00878.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES We examined a nationwide population-based dataset of patients with bipolar disorder (BD) hospitalized in Taiwan, with our analyses focusing on one-year medical costs and relapse rates. METHODS The data for this study, covering the years 2006 and 2007, were obtained from the Taiwan National Health Insurance (NHI) claims database. The study sample comprised BD patients who were discharged from hospitals between January 1 and December 31, 2006. Annual medical costs and relapse rates were described; the Kaplan-Meier method and the generalized linear models were carried out to examine the risk factors associated with cases of relapse. RESULTS The annual medical costs associated with relapses among the study sample were found to be approximately 7.6 times the average per-capita NHI expenditure in Taiwan in 2006 (US$4,354 versus US$574), with a one-year relapse rate of 55%. Those patients between 20 and 60 years old with a medication possession ratio of <80 and with depressive episodes during the recruitment period were identified as being at risk of relapse. CONCLUSION Bipolar disorder, which is a very costly disease, is associated with both poor medication adherence rates and frequent recurrences. Targeting drug adherence issues during maintenance treatment may well provide a valuable opportunity to reduce the risk of such recurrences.
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Affiliation(s)
- Chao-Hsiun Tang
- School of Health Care Administration, Gynecology Research Center, Taipei Medical University, Taipei, Taiwan
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Poor adherence to treatment associated with a high recurrence in a bipolar disorder outpatient sample. J Affect Disord 2010; 127:77-83. [PMID: 20576292 DOI: 10.1016/j.jad.2010.05.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 05/30/2010] [Accepted: 05/30/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND We analyzed the association of previous course-of-illness and other variables of clinical interest with a high frequency of both depressive or (hypo)manic episodes controlling for the effect of socio-demographic characteristics. METHODS A total of 108 outpatients with a DSM-IV diagnosis of bipolar disorder (BD) were recruited. A retrospective and naturalistic study was conducted to examine the number of affective episodes and their relationship with socio-demographic, clinical and course-of-illness variables, including adherence to medication, type of medication used and the use of addictive substances. The episode frequency was estimated as the number of "major instances" of depression, hypomania and mania during the illness. To classify the patients into two groups (higher and lower-episode frequency), we used the statistical criterion of median split. Results were analyzed with logistic regression models to control for the effects of potential confounders. RESULTS A high episode frequency (nine or more episodes) was associated with age (36-55years), delay in diagnosis, poor adherence to medication and current use of antipsychotic medication. In addition, a high frequency of manic episodes (four or more) was associated with female sex, age (>36years) and a manic onset of the illness, whereas a high frequency of depressive episodes (five or more) was associated with delay in diagnosis and poor adherence to medication. LIMITATIONS Cross-sectional study design. CONCLUSIONS Avoiding delay in diagnosis and enhancing treatment adherence might be important targets for reducing recurrences in BD.
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Abstract
OBJECTIVE To examine the association between treatment adherence and indirect productivity costs within a cohort of commercially insured employees with bipolar disorder in the United States. METHODS Adults diagnosed with bipolar disorder who had at least one prescription claim for a mood stabilizer or atypical antipsychotic, with 6 months prior and 12 months subsequent continuous medical and prescription coverage, were identified in the MarketScan research databases (2000-2005). Two-part multiple regression models estimated the association between adherence (medication possession ratio > or =0.80) and costs of absence, short-term disability, and workers' compensation. RESULTS Of 1258 eligible employees, only 35.3% were adherent. Relative to adherent employees, nonadherent employees had higher adjusted indirect costs due to absence (+$771.41), short-term disability (+$284.72), and workers' compensation (+$360.63). CONCLUSIONS Employers incur greater indirect costs when employees are not adherent to bipolar treatment.
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Validity of the adherence estimator in the prediction of 9-month persistence with medications prescribed for chronic diseases: a prospective analysis of data from pharmacy claims. Clin Ther 2010; 31:2584-607. [PMID: 20110004 DOI: 10.1016/j.clinthera.2009.11.030] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2009] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The aim of this article was to assess the predictive validity of the Adherence Estimator--a 3-item instrument designed to estimate a patient's propensity to adhere to medications prescribed for chronic disease. METHODS The Adherence Estimator was a 3-item part of a larger survey mailed to adults aged >or=40 years who had a qualifying index prescription filled in June 2008. A qualifying prescription was defined as one for a medication indicated for the treatment of 1 of 5 chronic diseases (cardiovascular disease, dyslipidemia [lipid-lowering drugs], diabetes [oral antihyperglycemics], osteoporosis [oral bisphosphonates], or asthma). Outcomes were compared between the adherence risk groups derived from the Adherence Estimator (low risk = score of 0, medium risk = score of 2-7, and high risk = score of 8-36). Treatment persistence over a period of 9 months was measured using pharmacy claims data. The primary outcome was the median proportion of days covered (PDC) by >or=1 medication during the first 9 months after the index fill. Secondary outcomes included adherence to the index medication, defined as PDC dichotomized to >or=0.80 or <0.80; rate of obtaining a second fill within 30 days of the index fill; and medication possession ratio (MPR) for refill adherence. RESULTS There were 1676 usable responses. Ages ranged from 40 to 88 years, with a mean of 64.6 years. Almost two thirds (1076/1676 [64.2%]) of the sample were female, and 1483/1676 (88.5%) were white. Statistically significant associations for all 3 pairwise comparisons (low vs medium risk, low vs high risk, and medium vs high risk) were observed between the Adherence Estimator risk groups for: (1) median PDC (0.655, 0.598, and 0.484 in the low-, medium-, and high-risk groups, respectively [all, false discovery rate [FDR] <0.05]); (2) PDC categorized (293/711 [41.21%], 200/588 [34.01%], and 105/377 [27.85%] [all, FDR <0.05]); and (3) rate of obtaining a second fill for the index medication within 30 days (489/711 [68.78%], 374/588 [63.61%], and 207/377 [54.91%] [all, FDR <0.05]). The low- and high-risk groups differed from one another on: (1) persistence with the index medication at 9 months (265/711 [37.27%] and 95/377 [25.20%]); (2) persistence with >1 medication at 9 months (291/711 [40.93%] and 108/377 [28.65%]); and (3) obtaining a second fill for any medication within 30 days (501/711 [70.46%] and 219/377 [59.09%]) (all, P < 0.05). The low- and high-risk groups differed significantly from one another in MPR for refill adherence (0.912 vs 0.866). Results observed within diseases mirrored those for the total sample, but with less precision. CONCLUSION In the present analysis of the validity of the Adherence Estimator in predicting adherence, baseline propensity to adhere to medications prescribed for chronic diseases was statistically associated with several measures of adherence and persistence, as derived from pharmacy claims data, over a 9-month period.
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Containing Cost Despite the Cost. Med Care 2010; 48:1-3. [DOI: 10.1097/mlr.0b013e3181caad9a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Outcomes and costs of patients with persistent asthma treated with beclomethasone dipropionate hydrofluoroalkane or fluticasone propionate. Adv Ther 2009; 26:762-75. [PMID: 19669630 DOI: 10.1007/s12325-009-0056-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Examine outcomes and costs of patients with persistent asthma who initiated treatment with beclomethasone dipropionate hydrofluoroalkane (BDP-HFA) or fluticasone propionate (FP). METHODS MedStat's Commercial Claims and Encounters database (July 1, 2002-June 30, 2007) was utilized. Patients (n=13,968) were included if they initiated treatment with BDP-HFA or FP (first use=index date). Patients also met these criteria: (a) no receipt of other study medication in the 1-year post-period; (b) persistent asthma in the 1-year pre-period; (c) age 5-64 years; (d) no diagnosis of chronic obstructive pulmonary disease; and (e) continuous insurance coverage from 1 year pre-period to 1 year post-period. Multivariate regressions examined the probability of an ER visit or hospitalization, probability of reaching alternative adherence thresholds, and costs. RESULTS Receipt of BDP-HFA, compared with FP, was associated with a 17% reduction in the odds of an ER visit (OR=0.834, 95% CI 0.751 to 0.925), a 30% reduction in the odds of an asthma-related ER visit (OR=0.697, 95% CI 0.571 to 0.852), and an increase in the odds of obtaining a medication possession ratio (MPR) of at least 50% (OR=1.324; 95% CI 1.164 to 1.506) or 75% (OR=1.311; 95% CI 1.072 to 1.604). Total medical costs ($5063 vs. $5377, P=0.0042), prescription drug costs ($2336 vs. $2581, P<0.0001), and ER costs ($185 vs. $249, P<0.0001) were significantly lower among the BDP-HFA cohort. Asthma-related outpatient ($191 vs. $224, P<0.0001) and ER costs ($28 vs. $45, P<0.001) were significantly lower in the BDP-HFA group, while asthma-related inpatient ($101 vs. $59, P<0.0001) and drug costs ($451 vs. $540, P<0.0001) were significantly lower in the FP cohort. CONCLUSIONS Results indicate that receipt of BDP-HFA, compared with receipt of FP, is associated with a decreased probability of ER visits or asthma-related ER visits and higher odds of reaching a medical possession ratio threshold of 50% or 75%. Receipt of BDP-HFA was also associated with lower total drug costs and lower total medical costs.
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