Bristol-Myers Squibb Company, Plaisboro, NJ, USA.
J Med Econ. 2012;15(1):105-11. doi: 10.3111/13696998.2011.632042. Epub 2011 Oct 28.
To examine the effect of antipsychotic medication half-life on the risk of psychiatric hospital admission and emergency department (ED) visits among adults with schizophrenia.
Retrospective claims-based cohort study of adult Medicaid patients with schizophrenia who were prescribed second-generation antipsychotic monotherapy following hospital discharge between 1/1/04 and 12/31/06. Cox proportional hazards models were applied to compare adjusted hazards of mental disorder admission among patients treated with oral antipsychotics that have either a long [risperidone (t(1/2) = 20 h), olanzapine (t(1/2) = 30 h), aripiprazole (t(1/2) = 75 h)] (n = 1479) or short [quetiapine (t(1/2) = 6 h), ziprasidone (t(1/2) = 7 h)] (n = 837) half-life. Day-level models controlled for baseline background characteristics and antipsychotic adherence over time as measured by gaps in the prescription record. Similar analyses examined either hospitalization or ED visits as separate endpoints.
A significantly lower rate of hospitalization/ED visits was evident for long (0.74/patient-year) vs short (1.06/patient-year) half-life antipsychotics (p < 0.001). The unadjusted rate of hospitalization alone was significantly lower for long (0.38/patient-year) vs short (0.52/patient-year) half-life antipsychotics (p = 0.005). Compared with short half-life antipsychotic drugs, the adjusted hazard ratio associated with long half-life medications was 0.77 (95% CI = 0.67-0.88) for combined hospitalization/ED visits and 0.80 (95% CI = 0.67-0.96) for hospitalization. The corresponding number needed to treat with long, rather than short, half-life medications to avoid one hospitalization was 16 patients for 1 year and to avoid one hospitalization or ED visit was 11 patients for 1 year.
This study demonstrated an association between antipsychotic medication half-life and hospitalization, not a causal link. Patients using long half-life medications had fewer comorbid mental health conditions and took fewer psychiatric medications at baseline. Other unmeasured differences may have existed between groups and may partially account for the findings.
In schizophrenia management, longer-acting second-generation antipsychotics were associated with a lower risk of hospital admission/ED visits for mental disorders.
研究抗精神病药物半衰期对精神分裂症成年患者精神病住院和急诊就诊风险的影响。
这是一项基于回顾性索赔的队列研究，纳入了在 2004 年 1 月 1 日至 2006 年 12 月 31 日期间出院后接受第二代抗精神病药单药治疗的成年医疗补助精神分裂症患者。应用 Cox 比例风险模型比较了接受半衰期较长[利培酮（t(1/2)=20 小时）、奥氮平（t(1/2)=30 小时）、阿立哌唑（t(1/2)=75 小时）]（n=1479）或较短[喹硫平（t(1/2)=6 小时）、齐拉西酮（t(1/2)=7 小时）]（n=837）半衰期的口服抗精神病药治疗的患者之间的精神障碍入院调整风险比。天级模型控制了基线背景特征和通过处方记录中的空白来衡量的抗精神病药物随时间的依从性。类似的分析分别以住院或急诊就诊作为单独的终点。
半衰期较长（0.74/患者年）与半衰期较短（1.06/患者年）的抗精神病药物相比，住院/急诊就诊的发生率明显较低（p<0.001）。半衰期较长（0.38/患者年）与半衰期较短（0.52/患者年）的抗精神病药物相比，单独住院的未调整发生率明显较低（p=0.005）。与半衰期较短的抗精神病药物相比，半衰期较长药物相关的调整后风险比与联合住院/急诊就诊相关的为 0.77（95%CI=0.67-0.88），与住院相关的为 0.80（95%CI=0.67-0.96）。为避免 1 次住院，需要用半衰期较长而非较短的药物治疗的患者数为 16 例，为避免 1 次住院或急诊就诊，需要用半衰期较长而非较短的药物治疗的患者数为 11 例，治疗时长均为 1 年。
本研究证明了抗精神病药物半衰期与住院之间的关联，而非因果关系。使用半衰期较长的药物的患者在基线时合并的精神健康状况较少，且服用的精神科药物较少。两组之间可能存在其他未测量的差异，这些差异可能部分解释了研究结果。
在精神分裂症管理中，长效第二代抗精神病药物与较低的精神障碍住院/急诊就诊风险相关。
