Cost of Antipsychotic Polypharmacy in the Treatment of Schizophrenia

Eli Lilly and Company, Indianapolis, Indiana, USA.
BMC Psychiatry (Impact Factor: 2.21). 04/2008; 8(1):19. DOI: 10.1186/1471-244X-8-19
Source: PubMed


This study compared the costs of antipsychotic polypharmacy for patients who initiated on 1 of the 3 most commonly prescribed atypical antipsychotics - olanzapine, quetiapine, or risperidone.
Data were drawn from a large, prospective, naturalistic, multi-site, nonrandomized study of treatment for schizophrenia in the United States conducted between July 1997 and September 2003. Participants who were initiated on olanzapine (N = 405), quetiapine (N = 115), or risperidone (N = 276) were followed for 1 year post initiation and compared on: (a) average daily cost of the index antipsychotic while on the index antipsychotic, (b) average daily cost of the coprescribed antipsychotics while on the index antipsychotic, (c) average daily cost of the index antipsychotic and the coprescribed antipsychotics while on the index antipsychotic, (d) total annual cost of antipsychotic medications prescribed in the year following initiation on the index antipsychotic, using propensity score-adjusted bootstrap resampling method. Average daily antipsychotic costs and total annual antipsychotic costs were also estimated using more recent (2004) antipsychotic drug prices.
During the 1 year following initiation on the index antipsychotic, the total average daily cost of the index antipsychotic was higher for quetiapine ($15.33) than olanzapine ($13.90, p < .05) and risperidone ($11.04, p < .01), although the average daily cost of the index antipsychotic was higher for olanzapine ($10.08) than risperidone ($6.74, p < .01) or quetiapine ($6.63, p < .01). Lower total average daily costs were observed in risperidone than olanzapine or quetiapine. Significantly lower average daily cost of concomitant antipsychotic medications for olanzapine ($3.82) compared to quetiapine ($8.70, p < .01) or risperidone-initiated patients ($4.30, p < .01) contributed to the lower average daily cost of all antipsychotic medication for olanzapine-initiated patients. Each dollar spent on the index antipsychotic was accompanied by spending an additional $1.31 on concomitant antipsychotics for quetiapine compared to $0.64 for risperidone and $0.38 for olanzapine-initiated patients. A separate intent-to-treat analysis of the total annual antipsychotic cost found a significantly higher total annual antipsychotic cost for quetiapine-initiated patients ($5320) compared to olanzapine ($4536, p < .01) or risperidone ($3813, p < .01).
Prevalent antipsychotic polypharmacy adds substantial cost to the treatment of schizophrenia. Comparison of medication costs need to address the costs of all antipsychotics. A better understanding of concomitant antipsychotic costs provides a more accurate portrayal of antipsychotic medication costs in the treatment of schizophrenia.

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    • "The prevalence of antipsychotic polypharmacy has been reported to be between 13 and 70%.[49101112] Despite advantages or disadvantages of antipsychotic polypharmacy, it increases treatment costs at a time of increasing budget constraints.[4121314151617] In the United Kingdom, 20.0% of the total burden of disease was attributable to mental illness compared with 17.2% to cardiovascular diseases and 15.5% to cancer. "
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    ABSTRACT: Antipsychotic monotherapy or polypharmacy (concurrent use of two or more antipsychotics) are used for treating patients with psychiatric disorders (PDs). Usually, antipsychotic monotherapy has a lower cost than polypharmacy. This study aimed to predict the cost of antipsychotic medications (AM) of psychiatric patients in Iran. For this purpose, 790 patients with PDs who were discharged between June and September 2010 were selected from Razi Psychiatric Hospital, Tehran, Iran. For cost prediction of AM of PD, neural network (NN) and multiple linear regression (MLR) models were used. Analysis of data was performed with R 2.15.1 software. Mean ± standard deviation (SD) of the duration of hospitalization (days) in patients who were on monotherapy and polypharmacy was 31.19 ± 15.55 and 36.69 ± 15.93, respectively (P < 0.001). Mean and median costs of medication for monotherapy (n = 507) were $8.25 and $6.23 and for polypharmacy (n =192) were $13.30 and $9.48, respectively (P = 0.001). The important variables for cost prediction of AM were duration of hospitalization, type of treatment, and type of psychiatric ward in the MLR model, and duration of hospitalization, type of diagnosed disorder, type of treatment, age, Chlorpromazine dosage, and duration of disorder in the NN model. Our findings showed that the artificial NN (ANN) model can be used as a flexible model for cost prediction of AM.
    Journal of research in medical sciences 09/2013; 18(9):782-5. · 0.65 Impact Factor
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    • "In the present study 30% and 41.1% of RLAI and FGAI patients, respectively, were using additional oral antipsychotics. In clinical practice, antipsychotic polypharmacy has been reported to range from 13% to 60% and can have a significant impact on schizophrenia patient outcomes [25,26]. However, in the present study polypharmacy did not appear to impact the observed outcomes. "
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    ABSTRACT: Background Depot formulations of antipsychotics provide a potential solution to the poor adherence to oral therapies in schizophrenia. However, there have been few comparative studies on the effectiveness and tolerability of first and second generation depot antipsychotics in a real clinical practice setting. The objectives of the present study were to compare safety and outcomes in patients with schizophrenia initiated on risperidone long-acting injection (RLAI) or first generation antipsychotic injections (FGAI) at a Mental Health Centre in British Columbia. Methods Data were collected by retrospective chart review of all active patients starting depot therapy who were ≥ 18 years of age, had received at least 3 injections of depot antipsychotic and had no prior clozapine treatment. Kaplan Meier survival curves were used to estimate probability of treatment discontinuation and hospitalization. Results A total of 70 RLAI and 102 FGAI patient charts were reviewed. At baseline patients in both groups had similar ages (39.7 and 42.7 years for RLAI and FGAI patients (p = 0.09), respectively) but FGAI patients had a longer time since diagnosis (13.6 vs. 9.85 years (p = 0.003)). Treatment retention at 18 months was 77% for RLAI and 86% for FGAI patients (p = 0.22) and 82% and 88% of patients, respectively (p = 0.28), had not been hospitalized. However, RLAI analyses were compromised by lack of long-term patient data. Concomitant medication utilization was similar in both groups except for anticholinergics which were used less frequently in RLAI patients (5.7% vs. 35.3%, p < 0.001). Adverse event frequency was also similar except for extrapyramidal symptoms (EPS) which were more common in FGAI patients (52.9% vs. 17.0% for RLAI (p < 0.001)). Conclusions There was no apparent difference in treatment discontinuation or hospitalization between RLAI and FGAI treated patients, although analysis was compromised by low patient numbers. However, decreased EPS with RLAI may offer a significant clinical benefit to patients with schizophrenia.
    BMC Psychiatry 05/2013; 13(1):155. DOI:10.1186/1471-244X-13-155 · 2.21 Impact Factor
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    • "Antipsychotic polypharmacy has been scrutinized mainly because of the disproportionate lack of evidence for its effectiveness and safety (Waddington et al., 1998; Stahl 1999; Stahl 2002a, 2002b; Miller and Craig., 2002; Centorrino et al., 2004; Joukamaa et al., 2006; Correll et al., 2007; Correll, 2008; Tranulis et al., 2008; Kessing et al., 2010) and cost (Rupnow et al. 2007; Valuck et al. 2007; Zhu et al. 2008). Two meta-analyses showed somewhat inconclusive results, in that superiority of antipsychotic polypharmacy might be mediated by potentially confounding factors, such as open treatment (Barbui et al., 2009), or by country in which the study was performed, therapeutic vs. low dose combinations, or cotreatment from the inception of antipsychotic treatment (Correll et al., 2009). "
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    ABSTRACT: Although common in psychiatric practice, reasons for antipsychotic polypharmacy (APP) have remained unclear. Single-site, semi-structured interview study of prescribers at a psychiatric teaching hospital inquiring about APP attitudes and behaviors, including frequency, preferred combinations, rationale and concerns. Forty-four prescribers reported using APP in 17.0 ± 10.0% of antipsychotic-treated patients. Although clinicians themselves initiated APP in only 23.3 ± 27.0% of cases, they did not attempt conversion to antipsychotic monotherapy in 40.9 ± 37.7%, despite reported successful conversion in 28.0 ± 30.8% of cases. The following reasons justified most APP (0-10): cross-titration (9.2 ± 1.4), failed clozapine trial (8.2 ± 2.2), randomized controlled evidence (8.0 ± 2.0), and clozapine intolerance (7.7 ± 2.6). Prescribers felt "moderately" (5.0 ± 1.9) concerned about APP (0-10), mostly due to chronic side effects (7.6 ± 2.0), lack of evidence (7.1 ± 2.2), non-adherence risk (6.7 ± 2.3) and mortality risk (6.7 ± 3.2), while increased cost (4.9 ± 2.5) and higher total antipsychotic dose (4.2 ± 2.9) ranked lowest. Comparing high with low APP prescribers (>10% vs. ≤ 10% of patients; mean: 36.1 ± 19.8 vs. 3.4 ± 3.4, p<0.0001), no differences emerged on 25/26 ratings regarding APP justification and 9/9 ratings regarding concerns. In a multivariate analyses, only attending status (OR=10.3, p=0.0043) and endorsing a specific APP preference (OR=21.4, p=0.011) predicted APP use >10% (r(2):0.35, p<0.0001), yet no uniformly preferred APP strategy emerged. High APP prescribers had more clinical experience, less concerns about APP and more likely a preferred APP choice, although no overall preferred strategy emerged. Otherwise, high and low APP prescribers shared attitudes toward APP. Both had inherited most of their APP cases and were reluctant to convert patients to antipsychotic monotherapy.
    Schizophrenia Research 03/2011; 131(1-3):58-62. DOI:10.1016/j.schres.2011.02.016 · 3.92 Impact Factor
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