a Medical College of Georgia , Augusta , GA , USA.
b Teva Pharmaceutical Industries , Malvern , PA , USA.
Curr Med Res Opin. 2019 Jul;35(7):1205-1214. doi: 10.1080/03007995.2019.1569871. Epub 2019 Feb 15.
To assess the impact of developing tardive dyskinesia (TD), both with and without other pre-existing extrapyramidal symptoms (EPS), on healthcare resource utilization (HRU) among patients with mental disorders receiving antipsychotic medications. Data on patients receiving antipsychotics who had schizophrenia, major depressive disorder or bipolar disorder were extracted from a Medicaid claims database. Separate cohorts of TD patients with and without other EPS ("TD + EPS" and "TD non-EPS") were constructed and matched to patients in a non-TD/EPS control cohort at a ∼1:5 ratio. HRU outcomes were assessed using descriptive statistics and difference-in-differences techniques over baseline and follow-up periods defined as the 6 months before and after TD development, respectively. The TD + EPS ( = 289) and TD non-EPS ( = 394) cohorts were matched with 1398 and 1922 control patients, respectively. The percentage of patients with all-cause and mental-disorder-related inpatient admissions increased from baseline to follow-up in the TD + EPS (12.8% and 12.5%, respectively) and TD non-EPS (16.0% and 13.5%) cohorts; by contrast, slight decreases (∼3%) in these outcomes were observed in the matched controls. Difference-in-differences analyses demonstrated that development of TD was associated with a statistically significant increase of ∼15-19% in the percentage of patients with all-cause and mental-disorder-related inpatient admissions/visits. The within-cohort change from baseline to follow-up in the use of potential drugs for TD or EPS was similar between the TD cohorts and their matched controls. This study demonstrates a significant economic burden associated with developing TD, as captured by increased HRU including inpatient admissions and ER visits.
评估迟发性运动障碍（TD）的发展对接受抗精神病药物治疗的精神障碍患者的医疗资源利用（HRU）的影响，无论是否伴有其他先前存在的锥体外系症状（EPS）。从医疗补助索赔数据库中提取了接受抗精神病药物治疗的患有精神分裂症、重度抑郁症或双相情感障碍的患者的数据。构建了 TD 患者伴有和不伴有其他 EPS 的单独队列（“TD+EPS”和“TD 无 EPS”），并以 1:5 的比例与非 TD/EPS 对照组的患者进行匹配。使用描述性统计和差异中的差异技术评估 HRU 结果基线和随访期间分别定义为 TD 发展前和后 6 个月。TD+EPS（ = 289）和 TD 无 EPS（ = 394）队列分别与 1398 名和 1922 名对照患者匹配。所有原因和精神障碍相关住院入院率的患者百分比从基线增加到 TD+EPS（分别为 12.8%和 12.5%）和 TD 无 EPS（分别为 16.0%和 13.5%）队列；相比之下，在匹配的对照中，这些结果略有下降（约 3%）。差异中的差异分析表明，TD 的发展与所有原因和精神障碍相关住院入院/就诊患者的百分比增加了约 15-19%具有统计学意义。从基线到随访，TD 队列与其匹配对照之间潜在 TD 或 EPS 药物使用的队列内变化相似。本研究表明，与 TD 发展相关的 HRU 增加，包括住院和急诊就诊，与显著的经济负担相关。
