Patterns of relapse and associated cost burden in schizophrenia patients receiving atypical antipsychotics

Lafeuille, Marie-Hélène; Gravel, Jonathan; Lefèbvre, Patrick; Fastenau, John; Muser, Erik; Doshi, Dilesh; Duh, Mei Sheng

doi:10.3111/13696998.2013.841705

Cited by 39 publications

(27 citation statements)

References 20 publications

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“…These results are of key importance particularly given that poor adherence to medication is an important driver of relapse in schizophrenic patients11 and that relapses are associated with a significant increase in health care costs mostly due to institutional visits (ie, hospitalizations and emergency department visits) 24,25. Reasons for poor adherence to AP medication in patients with schizophrenia have been largely investigated and include, in addition to factors related to the medication itself, lack of illness awareness, direct impacts of symptoms, social isolation, comorbid substance misuse, stigma, and the increasing fragmentation of mental health services in many countries 10.…”

Section: Discussionmentioning

confidence: 99%

Treatment patterns in Medicaid patients with schizophrenia initiated on a first- or second-generation long-acting injectable versus oral antipsychotic

Pilon¹,

Joshi²,

Tandon³

et al. 2017

PPA

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BackgroundPoor antipsychotic (AP) adherence is a key issue in patients with schizophrenia. First-generation antipsychotic (FGA) and second-generation antipsychotic (SGA) long-acting injectable therapies (LAI) may improve adherence compared to oral antipsychotics (OAP). The objective of the study was to compare treatment adherence and persistence in Medicaid patients with schizophrenia initiated on first-generation long-acting injectable therapies (FGA-LAI) or second-generation long-acting injectable therapies (SGA-LAI) versus OAP.MethodsAdults with schizophrenia initiated on FGA-LAI, SGA-LAI, or OAP on or after January 2010 were identified using a six-state Medicaid database (January 2009–March 2015). Outcomes were assessed during the 12 months following treatment initiation. Index medication adherence was assessed using the proportion of days covered ≥80%, while persistence was assessed as no gap of ≥30, ≥60, or ≥90 days between days of supply. Outcomes were compared between FGA/SGA-LAI and OAP cohorts using chi-squared tests and adjusted odds ratios (OR).ResultsDuring follow-up, AP polypharmacy was more common in FGA-LAI patients (N=1,089; 36%; P=0.029) and less common in SGA-LAI patients (N=2,209; 27%; P<0.001) versus OAP patients (N=20,478; 33%). After adjustment, SGA-LAI patients had 24% higher odds of adherence at 12 months (OR: 1.24; P<0.001), in contrast to FGA-LAI patients who had 48% lower odds of adherence (OR: 0.52; P<0.001) relative to OAP patients. SGA-LAI patients were more likely to be persistent (no gap ≥60 days) at 12 months than OAP patients (37% vs 30%; P<0.001), but not FGA-LAI patients (31% vs 30%; P=0.776). In comparison to OAP patients, SGA-LAI patients had 46% higher adjusted odds of persistence (no gap ≥60 days; OR: 1.46; P<0.001), while FGA-LAI patients were not significantly different (OR: 0.95; P=0.501).ConclusionMedicaid patients initiated on SGA-LAI demonstrated better treatment adherence and persistence compared to OAP patients, while those initiated on FGA-LAI did not show significant improvement in adherence or persistence and had more AP polypharmacy relative to OAP patients. These findings suggest the potential value of SGA-LAI in the treatment of schizophrenia.

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Section: Discussionmentioning

confidence: 99%

Treatment patterns in Medicaid patients with schizophrenia initiated on a first- or second-generation long-acting injectable versus oral antipsychotic

Pilon¹,

Joshi²,

Tandon³

et al. 2017

PPA

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“…Relapse is one of the most frequently cited drivers of costs associated with schizophrenia 27. Because nonadherence is a critical factor that leads to higher rates of relapse, credible approaches to monitoring adherence may decrease medical costs.…”

Section: Discussionmentioning

confidence: 99%

Access to credible information on schizophrenia patients’ medication adherence by prescribers can change their treatment strategies: evidence from an online survey of providers

Shafrin¹,

May²,

Shrestha³

et al. 2017

PPA

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ObjectiveOverestimating patients’ medication adherence diminishes the ability of psychiatric care providers to prescribe the most effective treatment and to identify the root causes of treatment resistance in schizophrenia. This study was conducted to determine how credible patient drug adherence information (PDAI) might change prescribers’ treatment decisions.MethodsIn an online survey containing 8 clinical case vignettes describing patients with schizophrenia, health care practitioners who prescribe antipsychotics to patients with schizophrenia were instructed to choose a preferred treatment recommendation from a set of predefined pharmacologic and non-pharmacologic options. The prescribers were randomly assigned to an experimental or a control group, with only the experimental group receiving PDAI. The primary outcome was the prescribers’ treatment choice for each case. Between-group differences were analyzed using multinomial logistic regression.ResultsA convenience sample (n=219) of prescribers completed the survey. For 3 nonadherent patient vignettes, respondents in the experimental group were more likely to choose a long-acting injectable antipsychotic compared with those in the control group (77.7% experimental vs 25.8% control; P<0.001). For 2 adherent but poorly controlled patient vignettes, prescribers who received PDAI were more likely to increase the antipsychotic dose compared with the control group (49.1% vs 39.1%; P<0.001). For the adherent and well-controlled patient vignette, respondents in both groups made similar treatment recommendations across all choices (P=0.099), but respondents in the experimental arm were more likely to recommend monitoring clinical stability (87.2% experimental vs 75.5% control, reference group).ConclusionThe results illustrate how credible PDAI can facilitate more appropriate clinical decisions for patients with schizophrenia.

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“…In the long-term paliperidone palmitate vs placebo relapse prevention study the rates of relapse during the 15-month double-blind period of the trial were 15% for patients taking paliperidone palmitate and 34% for patients taking placebo 11,12 . Relapses, in the context of schizophrenia, are personally debilitating and have large societal and economic burdens, with first episode average costs reported at $38,672 (2014 cost level) 14 .…”

Section: Discussionmentioning

confidence: 99%

Estimated medical cost reductions for paliperidone palmitate vs placebo in a randomized, double-blind relapse-prevention trial of patients with schizoaffective disorder

Joshi

Lin²,

Lingohr-Smith³

et al. 2015

Journal of Medical Economics

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Patterns of relapse and associated cost burden in schizophrenia patients receiving atypical antipsychotics

Abstract: Significant cost increases were observed with relapse in schizophrenia, driven mainly by institutional visits.

Cited by 39 publications

References 20 publications

Treatment patterns in Medicaid patients with schizophrenia initiated on a first- or second-generation long-acting injectable versus oral antipsychotic

Treatment patterns in Medicaid patients with schizophrenia initiated on a first- or second-generation long-acting injectable versus oral antipsychotic

Access to credible information on schizophrenia patients’ medication adherence by prescribers can change their treatment strategies: evidence from an online survey of providers

Estimated medical cost reductions for paliperidone palmitate vs placebo in a randomized, double-blind relapse-prevention trial of patients with schizoaffective disorder

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Patterns of relapse and associated cost burden in schizophrenia patients receiving atypical antipsychotics

Abstract: Significant cost increases were observed with relapse in schizophrenia, driven mainly by institutional visits.

Cited by 39 publications

References 20 publications

Treatment patterns in Medicaid patients with schizophrenia initiated on a first- or second-generation long-acting injectable versus oral antipsychotic

Treatment patterns in Medicaid patients with schizophrenia initiated on a first- or second-generation long-acting injectable versus oral antipsychotic

Access to credible information on schizophrenia patients&rsquo; medication adherence by prescribers can change their treatment strategies: evidence from an online survey of providers

Estimated medical cost reductions for paliperidone palmitate vs placebo in a randomized, double-blind relapse-prevention trial of patients with schizoaffective disorder

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Access to credible information on schizophrenia patients’ medication adherence by prescribers can change their treatment strategies: evidence from an online survey of providers