Economic Grand Rounds: Economic Costs of Failure to Monitor Adverse Effects of Second-Generation Antipsychotics: An Underestimated Factor

Abstract

Since 2003, the U.S. Food and Drug Administration as well as the American Diabetes Association, the American Psychiatric Association, and others have called for routine monitoring of cardiometabolic risk factors for patients of all ages prescribed second-generation antipsychotic medications. This survey of major public and private mental health treatment systems in 2010 found that adherence to such guidelines was limited. The authors describe some of the impediments to widespread monitoring of cardiometabolic risk factors among psychiatric patients taking second-generation antipsychotics and advocate for a nationwide commitment to providing the organizational and financial supports necessary to ensure systematic screening of cardiometabolic health among such patients.

Psychosis prevalence and physical, metabolic and cognitive co-morbidity: data from the second Australian national survey of psychosis

“…Moreover, only half (51.7%) of 2010 survey participants with hypertension were on medication for their condition; the figures for diabetes/hyperglycaemia and hypercholesterolaemia were even lower, at 39.8% and 39.4%, respectively (Galletly et al 2012). These findings support the need for improved primary care interventions for this population, and the integration of general medical and mental health treatment (Jerrell et al 2012). …”

Access to Psychosocial Services Prior to Starting Antipsychotic Treatment Among Medicaid-Insured Youth

“…A reduction in the use of antipsychotics may yield reduced pharmacy and medical costs associated with adverse effects of antipsychotics. [42][43][44] More research is needed to understand the complex array of factors that influence access and use of psychosocial treatments for children, and to identify strategies for improving access. Barriers to psychosocial services likely vary with treatment setting.…”

The Effects of Prior Authorization Policies on Medicaid-Enrolled Children's Use of Antipsychotic Medications: Evidence from Two Mid-Atlantic States

“…Policy makers' concern about the increased use of antipsychotics in children, particularly among children with disorders for which there is limited evidence of efficacy, is driven in part by strong evidence of the adverse effects of antipsychotic use, and by mounting evidence that children may be at even greater risk for adverse effects from these medications than adults (Correll and Carlson 2006;McIntyre and Jerrell 2008;Correll et al 2009;Crystal et al 2009), including weight gain (Correll and Carlson 2006) and diabetes (Hammerman et al 2008). States' concerns about the increased use of antipsychotics and the associated costs (Farley et al 2008;Jerrell et al 2012), coupled with the increased risk of adverse effects in individuals for whom there is limited support for the effectiveness of these medications, has led states to begin implementing a range of policies designed to influence the use of antipsychotics (Texas Health and Human Services Commission 2010; Vogt et al 2011). The most common approach, prior authorization-requiring physicians and patients to obtain approval before using a medication-has now been adopted by more than a third of state Medicaid programs (Soumerai et al 2008).…”