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Clinical and economic ramifications of switching antipsychotics in the treatment of schizophrenia.

Faries DE, Ascher-Svanum H, Nyhuis AW, Kinon BJ - BMC Psychiatry (2009)

Bottom Line: Compared with their counterparts who remained on their initial therapies, individuals who switched antipsychotics experienced a significantly higher risk of acute-care services, including hospitalization (p = .013) and crisis services (p = .011).Patients undergoing medication switches also used acute-care services significantly sooner (p = .004) and accrued an additional $3,000 (a 25% increase) in annual total health care costs per patient, most of which was due to acute-care expenditures.Switching antipsychotic medications was found to be associated with considerably poorer clinical and economic outcomes, as reflected by, more frequent and more rapid use of acute-care services compared with persons remaining on their initial treatments.

View Article: PubMed Central - HTML - PubMed

Affiliation: US Statistics, Lilly USA, LLC, Indianapolis, IN, USA. d.faries@lilly.com

ABSTRACT

Background: Switching between antipsychotic medications is common in the treatment of schizophrenia. However, data on clinical and economic outcomes from antipsychotic switching, in particular acute care service use, is fairly limited. The goal of this research was to assess the clinical and economic ramifications of switching antipsychotics during outpatient management of schizophrenia.

Methods: Data from a 1-year randomized, open-label cost-effectiveness study involving typical and atypical antipsychotics were assessed. The study protocol permitted switching of antipsychotics when clinically warranted. The risk of crisis-related events, use of acute-care services, and the time to the initial use of such services were determined in outpatients who switched antipsychotics compared with those who continued with their initial medications. Health care resource utilization data were abstracted from medical records and other sources (e.g., patient self-report), and direct costs were estimated using previously published benchmarks.

Results: Almost one-third of patients (29.3%) underwent a switch from their initial antipsychotic agent, with an average duration of 100 days before such treatment alterations. Compared with their counterparts who remained on their initial therapies, individuals who switched antipsychotics experienced a significantly higher risk of acute-care services, including hospitalization (p = .013) and crisis services (p = .011). Patients undergoing medication switches also used acute-care services significantly sooner (p = .004) and accrued an additional $3,000 (a 25% increase) in annual total health care costs per patient, most of which was due to acute-care expenditures.

Conclusion: Switching antipsychotic medications was found to be associated with considerably poorer clinical and economic outcomes, as reflected by, more frequent and more rapid use of acute-care services compared with persons remaining on their initial treatments.

Trial registration: Trial ID 2325 in LillyTrials.com (also accessible via ClinicalStudyResults.org).

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Related in: MedlinePlus

Risk of new acute-care service use (admissions).* *The percentage of days with new service use is calculated by the number of days with a new service (hospital admission, new partial hospitalization treatment, or ER admission) divided by the number of eligible days on treatment. Eligible days on treatment exclude days in which the previous day was spent hospitalized or in partial hospitalization.
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Figure 2: Risk of new acute-care service use (admissions).* *The percentage of days with new service use is calculated by the number of days with a new service (hospital admission, new partial hospitalization treatment, or ER admission) divided by the number of eligible days on treatment. Eligible days on treatment exclude days in which the previous day was spent hospitalized or in partial hospitalization.

Mentions: As shown in Figure 2, the risk of new acute-care service use (rate of admissions) was significantly higher among individuals switching antipsychotics (vs continuers) for any acute-care service (p < .001), hospitalization (p = .013), and crisis services (p = .011) but not partial hospitalization. Not only did switchers have higher risks of using new acute-care services; they also used such services significantly earlier than continuers (p = .006; Figure 3).


Clinical and economic ramifications of switching antipsychotics in the treatment of schizophrenia.

Faries DE, Ascher-Svanum H, Nyhuis AW, Kinon BJ - BMC Psychiatry (2009)

Risk of new acute-care service use (admissions).* *The percentage of days with new service use is calculated by the number of days with a new service (hospital admission, new partial hospitalization treatment, or ER admission) divided by the number of eligible days on treatment. Eligible days on treatment exclude days in which the previous day was spent hospitalized or in partial hospitalization.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2749836&req=5

Figure 2: Risk of new acute-care service use (admissions).* *The percentage of days with new service use is calculated by the number of days with a new service (hospital admission, new partial hospitalization treatment, or ER admission) divided by the number of eligible days on treatment. Eligible days on treatment exclude days in which the previous day was spent hospitalized or in partial hospitalization.
Mentions: As shown in Figure 2, the risk of new acute-care service use (rate of admissions) was significantly higher among individuals switching antipsychotics (vs continuers) for any acute-care service (p < .001), hospitalization (p = .013), and crisis services (p = .011) but not partial hospitalization. Not only did switchers have higher risks of using new acute-care services; they also used such services significantly earlier than continuers (p = .006; Figure 3).

Bottom Line: Compared with their counterparts who remained on their initial therapies, individuals who switched antipsychotics experienced a significantly higher risk of acute-care services, including hospitalization (p = .013) and crisis services (p = .011).Patients undergoing medication switches also used acute-care services significantly sooner (p = .004) and accrued an additional $3,000 (a 25% increase) in annual total health care costs per patient, most of which was due to acute-care expenditures.Switching antipsychotic medications was found to be associated with considerably poorer clinical and economic outcomes, as reflected by, more frequent and more rapid use of acute-care services compared with persons remaining on their initial treatments.

View Article: PubMed Central - HTML - PubMed

Affiliation: US Statistics, Lilly USA, LLC, Indianapolis, IN, USA. d.faries@lilly.com

ABSTRACT

Background: Switching between antipsychotic medications is common in the treatment of schizophrenia. However, data on clinical and economic outcomes from antipsychotic switching, in particular acute care service use, is fairly limited. The goal of this research was to assess the clinical and economic ramifications of switching antipsychotics during outpatient management of schizophrenia.

Methods: Data from a 1-year randomized, open-label cost-effectiveness study involving typical and atypical antipsychotics were assessed. The study protocol permitted switching of antipsychotics when clinically warranted. The risk of crisis-related events, use of acute-care services, and the time to the initial use of such services were determined in outpatients who switched antipsychotics compared with those who continued with their initial medications. Health care resource utilization data were abstracted from medical records and other sources (e.g., patient self-report), and direct costs were estimated using previously published benchmarks.

Results: Almost one-third of patients (29.3%) underwent a switch from their initial antipsychotic agent, with an average duration of 100 days before such treatment alterations. Compared with their counterparts who remained on their initial therapies, individuals who switched antipsychotics experienced a significantly higher risk of acute-care services, including hospitalization (p = .013) and crisis services (p = .011). Patients undergoing medication switches also used acute-care services significantly sooner (p = .004) and accrued an additional $3,000 (a 25% increase) in annual total health care costs per patient, most of which was due to acute-care expenditures.

Conclusion: Switching antipsychotic medications was found to be associated with considerably poorer clinical and economic outcomes, as reflected by, more frequent and more rapid use of acute-care services compared with persons remaining on their initial treatments.

Trial registration: Trial ID 2325 in LillyTrials.com (also accessible via ClinicalStudyResults.org).

Show MeSH
Related in: MedlinePlus