Novel antipsychotics and patient care in state hospitals

Hospitalization risks in the treatment of bipolar disorder: comparison of antipsychotic medications

OBJECTIVES

This study compared the relative risk for hospitalization of patients with bipolar and manic disorders receiving atypical and typical antipsychotics.

METHODS

This retrospective study was based on administrative claims data extracted from the PharMetrics database during 1999 through 2003. Comparisons were made among atypical antipsychotics (risperidone, olanzapine, quetiapine or ziprasidone), as well as between each of these versus a combined group of the leading typical antipsychotics. Relative risk for hospitalization was estimated with Cox proportional regression, which adjusted for differences in patient characteristics.

RESULTS

Risperidone and olanzapine demonstrated higher risks for hospitalization than quetiapine [hazard ratio (HR) 1.19, p < 0.05 for both], translating into higher annual mental health inpatient charges of $260 per patient. Risperidone and olanzapine also showed higher estimated risks than ziprasidone, which approached the p < 0.05 threshold. Differences between each of the atypicals and the combined typicals were not significant. Patients with putative rapid cycling had a threefold greater risk for hospitalization than other patients with bipolar disorder. In these patients, comparisons among atypical antipsychotics showed that risperidone had a significantly higher hospitalization risk than olanzapine (HR 3.31, p < 0.05), resulting in higher annual mental health inpatient charges of $4,930 per patient.

CONCLUSIONS

In the treatment of bipolar and manic disorders, risperidone and olanzapine were associated with a higher risk for hospitalization than quetiapine, and possibly ziprasidone. In the treatment of putative rapid cyclers, olanzapine was associated with a lower risk for hospitalization than risperidone.

Hospitalisation risks in the treatment of schizophrenia in a Medicaid population: comparison of antipsychotic medications

This study used administrative claims data to compare the relative risks for hospitalisation among patients with schizophrenia within a US Medicaid programme receiving atypical and typical antipsychotics. The newer atypical antipsychotics may be better tolerated among mentally ill patients receiving public assistance (Medicaid) who are less functional than other mentally ill populations. Risperidone, olanzapine, quetiapine and ziprasidone were compared with each other and to typical antipsychotics as a single category. Cox proportional hazard estimates, adjusted for differences in patient characteristics, showed numerically lower risks for each of the atypicals in comparison with the typicals, with that for quetiapine being statistically significant (HR: 0.672, p = 0.0413). There were no statistically significant differences among atypical pairs. This study provides evidence that risk for hospitalisation among Medicaid patients with schizophrenia may be lower with atypical antipsychotics, particularly quetiapine.

Hospitalization risks in the treatment of schizophrenia: comparison of antipsychotic medications

This study used administrative claims data to compare the relative risks for hospitalization among commercially insured patients with schizophrenia receiving atypical and typical antipsychotic drugs. Cox proportional hazard regression estimates, adjusted for differences in patient characteristics, suggested that among patients treated with the 4 atypical antipsychotic drugs, only olanzapine had a significantly higher risk for hospitalization than the typical antipsychotic drugs (hazard ratio [HR], 1.81; 95% confidence interval [CI], 1.20-2.75). In addition, risk for hospitalization with olanzapine was significantly higher than that for risperidone (HR, 1.34; 95% CI, 1.03-1.74) and numerically higher than that for quetiapine (HR, 1.40; 95% CI, 0.94-2.07). Overall, olanzapine was associated with a higher risk for hospitalization than the typical antipsychotic drugs and among the atypical antipsychotic drugs, risperidone and, potentially, quetiapine.