College of Pharmacy, University of Texas, PHR 3.210, Austin, TX 78712, USA.
Psychiatr Serv. 2011 Sep;62(9):1032-40. doi: 10.1176/ps.62.9.pss6209_1032.
A retrospective study using Medicaid claims identified patients with bipolar disorder for whom oral second-generation antipsychotics were prescribed and compared rates of adherence, persistence of use, and costs across five groups of patients taking aripiprazole, olanzapine, quetiapine, risperidone, or ziprasidone.
Medicaid claims data for 2,446 bipolar patients were analyzed from eight states. The 18-month observation period included the six months before and the 12 months after the index prescription date. Adherence was defined as a medication possession ratio >80%. Persistence of use was measured by the number of days of medication therapy before a 30-day gap. Mental health-related prescription costs, total prescription costs, total mental health-related costs, and total costs were assessed. Ziprasidone was the comparator.
Clinically recommended doses of second-generation antipsychotic medications were prescribed for 45% of the patients (N = 1,102). Of these, 58% (N = 642 of 1,102) were adherent with the prescribed medication, with no significant differences between medication groups. Median time to nonpersistence of use averaged 96 days. Patients taking olanzapine were about 35% more likely than patients taking ziprasidone to discontinue taking their medication (hazard ratio = 1.34, 95% confidence interval = 1.02-1.76, p = .04). Mental health-related prescription costs and total prescription costs were lower for risperidone than ziprasidone. No statistically significant differences were found between the groups for all mental health-related costs or total costs.
Among patients in a sizeable Medicaid cohort for whom a second-generation antipsychotic medication was prescribed, less than half had a clinically recommended dose, and less than two-thirds with a clinically recommended dose were adherent to the medication, confirming that many patients with bipolar disorder do not receive clinically recommended doses of second-generation antipsychotics.
一项使用医疗补助索赔数据的回顾性研究确定了服用口服第二代抗精神病药物的双相情感障碍患者，并比较了服用阿立哌唑、奥氮平、喹硫平、利培酮或齐拉西酮的五组患者的依从率、持续使用率和成本。
对来自八个州的 2446 名双相情感障碍患者的医疗补助索赔数据进行了分析。18 个月的观察期包括索引处方日期前的六个月和后十二个月。依从性定义为药物持有率>80%。通过在 30 天空白期前的用药天数来衡量用药的持续时间。评估了心理健康相关处方药费用、总处方药费用、总心理健康相关费用和总费用。齐拉西酮为对照组。
为 45%的患者（N=1102）开出了第二代抗精神病药物的临床推荐剂量。其中，58%（N=1102 中的 642 人）对规定的药物有依从性，各组之间没有显著差异。非持续用药的中位时间平均为 96 天。与服用齐拉西酮的患者相比，服用奥氮平的患者停止服用药物的可能性高 35%（风险比=1.34，95%置信区间=1.02-1.76，p=0.04）。利培酮的心理健康相关处方药费用和总处方药费用低于齐拉西酮。各组之间的所有心理健康相关费用或总费用均无统计学差异。
在接受第二代抗精神病药物治疗的大量医疗补助队列患者中，不到一半的患者接受了临床推荐剂量，不到三分之二接受了临床推荐剂量的患者对药物有依从性，这证实了许多双相情感障碍患者并未接受第二代抗精神病药物的临床推荐剂量。
