Driessen Julia, Baik Seo Hyon, Zhang Yuting
Dr. Driessen and Dr. Zhang are with the Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, Pennsylvania (e-mail:
Psychiatr Serv. 2016 Aug 1;67(8):898-903. doi: 10.1176/appi.ps.201500316. Epub 2016 Apr 15.
The study evaluated trends in the off-label use of second-generation antipsychotics in the Medicare population, a practice that has been identified as lacking adequate supporting evidence for many indications.
Medicare claims data from 2006 to 2012 were used to identify beneficiaries who filled at least one prescription for any second-generation antipsychotic. Any use that was not associated with a medical claim for an approved indication in a given year was classified as off-label use. Rates of off-label use and of diagnoses associated with off-label use were compared over time. Fill counts standardized for 30-day supply and costs were compared by type of use.
On the basis of a sample of 490,314 patient-years, the rate of off-label use among beneficiaries prescribed a second-generation antipsychotic declined from 51% to 45%. Fill counts were 16% lower for off-label users compared with on-label users. Off-label users had higher out-of-pocket costs but lower total costs for second-generation antipsychotics. Off-label users most commonly had claims related to dementia, minor depression, anxiety disorders, and other psychosis. The proportion of off-label users without any claims for the most common off-label uses of second-generation antipsychotics declined from 45% in 2006 to 30% in 2012.
Off-label use of second-generation antipsychotics has declined, especially among persons without any of the common off-label conditions. The diagnoses accompanying off-label use did not systematically reflect changes in the evidence base for the use of these drugs, suggesting a mismatch between evidence supporting the use of off-label second-generation antipsychotics and prescribing practices.
本研究评估了医疗保险人群中第二代抗精神病药物的非标签使用趋势，这种做法在许多适应症方面缺乏充分的支持证据。
使用2006年至2012年的医疗保险理赔数据来确定至少开具过一次任何第二代抗精神病药物处方的受益人。在特定年份中，任何与已批准适应症的医疗理赔无关的使用都被归类为非标签使用。比较不同时间的非标签使用率以及与非标签使用相关的诊断率。按使用类型比较标准化为30天供应量的配药次数和费用。
基于490,314患者年的样本，开具第二代抗精神病药物的受益人中非标签使用率从51%降至45%。与标签内使用者相比，非标签使用者的配药次数低16%。非标签使用者的自付费用较高，但第二代抗精神病药物的总费用较低。非标签使用者最常见的理赔与痴呆、轻度抑郁、焦虑症和其他精神病有关。在第二代抗精神病药物最常见的非标签使用中，无任何理赔的非标签使用者比例从2006年的45%降至2012年的30%。
第二代抗精神病药物的非标签使用有所下降，尤其是在没有任何常见非标签病症的人群中。与非标签使用相关的诊断并未系统地反映这些药物使用证据基础的变化，这表明支持第二代抗精神病药物非标签使用的证据与处方实践之间存在不匹配。
