Gianfrancesco Frank D, Sajatovic Martha, Rajagopalan Krithika, Wang Ruey-Hua
HECON Associates, Inc., Montgomery Village, Maryland 20886, USA.
Clin Ther. 2008 Jul;30(7):1358-74. doi: 10.1016/s0149-2918(08)80062-8.
Up to 48% of patients with bipolar disorder are either nonadherent or partially adherent to antipsychotic drug treatment. Medication adherence may differ by bipolar disorder subtype.
This study evaluated the association between antipsychotic treatment adherence and mental health care use among individuals with bipolar disorder with predominantly manic/mixed symptoms or predominantly depressive symptoms.
Individuals with bipolar or manic disorder who had at least 1 medical claim with International Classification of Diseases, Ninth Revision, Clinical Modification codes 296.4-296.8 (bipolar disorder) or 296.0 or 296.1 (manic disorder) were identified from medical and pharmacy claims in the PharMetrics database for the period from January 1999 through December 2004. Adherence was measured by intensity (medication possession ratio [MPR]) and treatment duration. The association between adherence and health care use during and after antipsychotic treatment was evaluated using multiple regression analysis. The traditional P < 0.05 threshold was used for statistical significance; however, results that approached significance at P < 0.10 were also noted.
Claims data were examined for 13,941 antipsychotic treatment episodes occurring in 12,952 individuals with bipolar or manic disorder. Of these, 6153 treatment episodes occurred in 5711 individuals with predominantly manic/mixed symptoms, and 2617 occurred in 2381 individuals with predominantly depressive symptoms. The remaining 5171 treatment episodes occurred in 4860 individuals with unspecified bipolar disorder and were not included in the analysis. In individuals with manic/mixed symptoms, a higher MPR was associated with reduced total and outpatient mental health expenditures over subsequent stages of treatment (reduction in total expenditure per 1-point increment in MPR: $123-$439; P < 0.001). In individuals with predominantly depressive symptoms, the association between MPR and subsequent mental health expenditure reached statistical significance only in months 10-12, the 3rd of the 4 treatment segments examined (total mental health expenditure: -$714 [P < 0.001]; outpatient mental health expenditure: -$468 [P < 0.001]). A higher MPR was also associated with a lower likelihood of acute mental health care (inpatient hospitalization or an emergency department visit) in subsequent months in individuals with manic/mixed symptoms or depressive symptoms (odds ratio = 0.545 [95% CI, 0.30- 1.00] and 0.395 [95% CI, 0.14-1.12], respectively; both NS at the P < 0.05 threshold), and was not associated with mental health inpatient days. In both subgroups, a longer duration of treatment was associated with lower total and outpatient mental health expenditures during the 4 months after the termination of treatment (both, P < 0.01).
In these individuals with bipolar or manic disorder, improved adherence to antipsychotic treatment was associated with lower subsequent total and outpatient mental health care expenditures. This association was less pronounced in individuals with predominantly depressive symptoms than in those with predominantly manic/mixed symptoms.
高达48%的双相情感障碍患者对抗精神病药物治疗不依从或部分依从。药物依从性可能因双相情感障碍亚型而异。
本研究评估了以躁狂/混合症状为主或抑郁症状为主的双相情感障碍患者中，抗精神病药物治疗依从性与精神卫生保健利用之间的关联。
从PharMetrics数据库1999年1月至2004年12月期间的医疗和药房理赔记录中，识别出患有双相情感障碍或躁狂症且至少有1次国际疾病分类第九版临床修订本编码为296.4 - 296.8（双相情感障碍）或296.0或296.1（躁狂症）的医疗理赔记录的个体。依从性通过强度（药物持有率[MPR]）和治疗持续时间来衡量。使用多元回归分析评估抗精神病药物治疗期间及之后依从性与卫生保健利用之间的关联。采用传统的P < 0.05阈值判定统计学显著性；然而，P < 0.10且接近显著性的结果也予以记录。
对12,952例双相情感障碍或躁狂症患者发生的13,941次抗精神病药物治疗事件的理赔数据进行了检查。其中，5711例以躁狂/混合症状为主的个体发生了6153次治疗事件，2381例以抑郁症状为主的个体发生了2617次治疗事件。其余5171次治疗事件发生在4860例未明确双相情感障碍的个体中，未纳入分析。在以躁狂/混合症状为主的个体中，较高的MPR与治疗后续阶段的总精神卫生支出和门诊精神卫生支出减少相关（MPR每增加1分，总支出减少：123美元 - 439美元；P < 0.001）。在以抑郁症状为主的个体中，MPR与后续精神卫生支出之间的关联仅在检查的4个治疗阶段中的第3个阶段，即第10 - 12个月达到统计学显著性（总精神卫生支出： - 714美元[P < 0.001]；门诊精神卫生支出： - 468美元[P < 0.001]）。较高的MPR还与以躁狂/混合症状或抑郁症状为主的个体在后续几个月中急性精神卫生保健（住院或急诊就诊）的可能性较低相关（优势比分别为0.545[95%置信区间，0.30 - 1.00]和0.395[95%置信区间，0.14 - 1.12]；在P < 0.05阈值时均无统计学显著性），且与精神科住院天数无关。在两个亚组中，治疗持续时间较长与治疗终止后4个月内的总精神卫生支出和门诊精神卫生支出较低相关（均P < 0.01）。
在这些双相情感障碍或躁狂症患者中，抗精神病药物治疗依从性的提高与后续较低的总精神卫生保健支出和门诊精神卫生保健支出相关。这种关联在以抑郁症状为主的个体中不如在以躁狂/混合症状为主的个体中明显。
