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Patterns of initiation of second generation antipsychotics for bipolar disorder: a month-by-month analysis of provider behavior.

Miller CJ, Li M, Penfold RB, Lee AF, Smith EG, Osser DN, Bajor L, Bauer MS - BMC Psychiatry (2014)

Bottom Line: Although efficacious, they have been costly and may cause significant side effects.Little is known about the factors associated with prescribers' decisions to initiate SGA prescriptions for this condition.Most medical comorbidities were only modestly associated with overall SGA initiation, although significant differences emerged among individual SGAs.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Several second generation antipsychotics (SGAs) received FDA approval for bipolar disorder in the 2000s. Although efficacious, they have been costly and may cause significant side effects. Little is known about the factors associated with prescribers' decisions to initiate SGA prescriptions for this condition.

Methods: We gathered administrative data from the Department of Veterans Affairs on 170,713 patients with bipolar disorder between fiscal years 2003-2010. Patients without a prior history of taking SGAs were considered eligible for SGA initiation during the study (n =126,556). Generalized estimating equations identified demographic, clinical, and comorbidity variables associated with initiation of an SGA prescription on a month-by-month basis.

Results: While the number of patients with bipolar disorder using SGAs nearly doubled between 2003 and 2010, analyses controlling for patient characteristics and the rise in the bipolar population revealed a 1.2% annual decline in SGA initiation during this period. Most medical comorbidities were only modestly associated with overall SGA initiation, although significant differences emerged among individual SGAs. Several markers of patient severity predicted SGA initiation, including previous hospitalizations, psychotic features, and a history of other antimanic prescriptions; these severity markers became less firmly linked to SGA initiation over time. Providers in the South were somewhat more likely to initiate SGA treatment.

Conclusions: The number of veterans with bipolar disorder prescribed SGAs is rising steadily, but this increase appears primarily driven by a corresponding increase in the bipolar population. Month-by-month analyses revealed that higher illness severity predicted SGA initiation, but that this association may be weakening over time.

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Patients with bipolar disorder initiating SGAs, 2004–2010. Note: Figure 2 begins with 2004 since patients were not eligible to be labeled as SGA initiators until month 7 of 2003; see Methods for details.
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Fig2: Patients with bipolar disorder initiating SGAs, 2004–2010. Note: Figure 2 begins with 2004 since patients were not eligible to be labeled as SGA initiators until month 7 of 2003; see Methods for details.

Mentions: Figure 2 describes the nationwide number of patients newly initiated on an SGA each year, indicating between 5,109 and 6,745 patients entering the population of SGA users each year between 2004 and 2010 (mean = 5,951; 95% CI = 4,685-7,217; p < .0001). There was no significant change over time in the number of new initiators per year (annual average increase 11; 95% CI = −332-355; p = .9374). When combined with the steady increase in the population of patients with bipolar disorder, this meant that the odds of being newly initiated on an SGA actually decreased as the study progressed (annual OR 0.929; 95% CI = 0.924-0.933; p < .0001).Figure 2


Patterns of initiation of second generation antipsychotics for bipolar disorder: a month-by-month analysis of provider behavior.

Miller CJ, Li M, Penfold RB, Lee AF, Smith EG, Osser DN, Bajor L, Bauer MS - BMC Psychiatry (2014)

Patients with bipolar disorder initiating SGAs, 2004–2010. Note: Figure 2 begins with 2004 since patients were not eligible to be labeled as SGA initiators until month 7 of 2003; see Methods for details.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4256839&req=5

Fig2: Patients with bipolar disorder initiating SGAs, 2004–2010. Note: Figure 2 begins with 2004 since patients were not eligible to be labeled as SGA initiators until month 7 of 2003; see Methods for details.
Mentions: Figure 2 describes the nationwide number of patients newly initiated on an SGA each year, indicating between 5,109 and 6,745 patients entering the population of SGA users each year between 2004 and 2010 (mean = 5,951; 95% CI = 4,685-7,217; p < .0001). There was no significant change over time in the number of new initiators per year (annual average increase 11; 95% CI = −332-355; p = .9374). When combined with the steady increase in the population of patients with bipolar disorder, this meant that the odds of being newly initiated on an SGA actually decreased as the study progressed (annual OR 0.929; 95% CI = 0.924-0.933; p < .0001).Figure 2

Bottom Line: Although efficacious, they have been costly and may cause significant side effects.Little is known about the factors associated with prescribers' decisions to initiate SGA prescriptions for this condition.Most medical comorbidities were only modestly associated with overall SGA initiation, although significant differences emerged among individual SGAs.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Several second generation antipsychotics (SGAs) received FDA approval for bipolar disorder in the 2000s. Although efficacious, they have been costly and may cause significant side effects. Little is known about the factors associated with prescribers' decisions to initiate SGA prescriptions for this condition.

Methods: We gathered administrative data from the Department of Veterans Affairs on 170,713 patients with bipolar disorder between fiscal years 2003-2010. Patients without a prior history of taking SGAs were considered eligible for SGA initiation during the study (n =126,556). Generalized estimating equations identified demographic, clinical, and comorbidity variables associated with initiation of an SGA prescription on a month-by-month basis.

Results: While the number of patients with bipolar disorder using SGAs nearly doubled between 2003 and 2010, analyses controlling for patient characteristics and the rise in the bipolar population revealed a 1.2% annual decline in SGA initiation during this period. Most medical comorbidities were only modestly associated with overall SGA initiation, although significant differences emerged among individual SGAs. Several markers of patient severity predicted SGA initiation, including previous hospitalizations, psychotic features, and a history of other antimanic prescriptions; these severity markers became less firmly linked to SGA initiation over time. Providers in the South were somewhat more likely to initiate SGA treatment.

Conclusions: The number of veterans with bipolar disorder prescribed SGAs is rising steadily, but this increase appears primarily driven by a corresponding increase in the bipolar population. Month-by-month analyses revealed that higher illness severity predicted SGA initiation, but that this association may be weakening over time.

Show MeSH
Related in: MedlinePlus