1 Teva Pharmaceuticals, Frazer, Pennsylvania.
2 Truven Health Analytics, an IBM Watson Health Company, Durham, North Carolina.
J Manag Care Spec Pharm. 2019 Jul;25(7):810-816. doi: 10.18553/jmcp.2019.25.7.810.
Tardive dyskinesia (TD) is an often-irreversible movement disorder affecting any part of the body. Patients experience debilitating symptoms that lower quality of life and increase mortality. Prolonged exposure to dopamine antagonists, which are frequently prescribed for psychiatric disorders as neuroleptic (antipsychotic) drugs, is a common cause of TD. The estimated prevalence of TD is 20%-50% among patients on antipsychotics, and the reported incidence of TD ranges from < 1% to 42%, depending on the antipsychotics studied. However, there are few real-world studies examining health care utilization and the economic burden of TD.
To assess health care utilization and costs in a sample of patients with TD from the commercially insured and Medicare supplemental U.S.
A retrospective analysis was conducted using Truven MarketScan Commercial and Medicare administrative claims data. Patients were included in the TD group if they had the first TD diagnosis (index date) between January 1, 2008, and September 30, 2014, with ≥ 1 inpatient or ≥ 2 outpatient nondiagnostic claims for TD (ICD-9-CM code 333.85). Patients without TD were randomly assigned an index date. Further inclusion criteria for all patients were ≥ 12 months of pre- and post-index medical and pharmacy continuous enrollment and no evidence of TD claims during the pre-index period. Patients with TD were directly matched to patients without TD within subgroups for schizophrenia, major depressive disorder, bipolar disorder, and other psychiatric disorders and propensity matched on other demographic and clinical factors. Descriptive statistics on the incidence of resource utilization and costs of health care were reported.
Of 3,397 patients with TD, 834 met the selection criteria and were matched to 834 non-TD controls. Patients with TD generally had significantly greater utilization during the 12 months after TD diagnosis than in the 12 months before TD diagnosis. Their rates for health care utilization and costs were also substantially higher than for those without TD. During the post-TD-diagnosis time, inpatient admissions (55.5% vs. 26.1%; < 0.001) and emergency room visits (61.5% vs. 50.6%; < 0.001) occurred more for patients with TD than for patients without TD. Total health care costs were significantly greater for patients with TD than for those without TD ($54,656 vs. $28,777; < 0.001).
Patients diagnosed with TD demonstrate significantly higher health care utilization and costs compared with non-TD patients.
This study was funded by Teva Pharmaceuticals (Petach Tikva, Israel). Truven Health Analytics, an IBM Watson Health Company, received payment from Teva Pharmaceuticals for the analysis in this study. Carroll is employed by Teva Pharmaceuticals and Irwin is employed by Truven Health Analytics, an IBM Watson Health Company.
迟发性运动障碍（TD）是一种经常无法逆转的运动障碍，会影响身体的任何部位。患者会出现使人衰弱的症状，降低生活质量并增加死亡率。长期接触多巴胺拮抗剂（通常作为神经安定药（抗精神病药）开处方）是 TD 的常见病因。接受抗精神病药治疗的患者中，TD 的估计患病率为 20%-50%，而报告的 TD 发病率从<1%到 42%不等，具体取决于所研究的抗精神病药。然而，很少有真实世界的研究检查 TD 的医疗保健利用和经济负担。
评估美国商业保险和补充医疗保险患者中患有 TD 的患者的医疗保健利用和费用。
使用 Truven MarketScan 商业和医疗保险行政索赔数据进行回顾性分析。如果患者在 2008 年 1 月 1 日至 2014 年 9 月 30 日之间有首次 TD 诊断（索引日期），且有≥1 次住院或≥2 次非诊断性门诊 TD （ICD-9-CM 代码 333.85），则将其归入 TD 组。无 TD 的患者随机分配一个索引日期。所有患者的进一步纳入标准为在索引前和索引后至少 12 个月的医疗和药房连续入组，且在索引前期间无 TD 索赔的证据。在亚组中，将 TD 患者与无 TD 患者按精神分裂症、重度抑郁症、双相情感障碍和其他精神障碍进行匹配，并在其他人口统计学和临床因素上进行倾向匹配。报告了医疗保健资源利用和成本的发生率的描述性统计数据。
在 3397 名患有 TD 的患者中，有 834 名符合选择标准，并与 834 名非 TD 对照相匹配。患有 TD 的患者通常在 TD 诊断后 12 个月内的利用情况明显高于 TD 诊断前 12 个月。他们的医疗保健利用率和费用率也明显高于无 TD 的患者。在 TD 诊断后的时间内，患有 TD 的患者的住院入院率（55.5%比 26.1%；<0.001）和急诊就诊率（61.5%比 50.6%；<0.001）均高于无 TD 的患者。患有 TD 的患者的总医疗保健费用明显高于无 TD 的患者（54656 美元比 28777 美元；<0.001）。
与非 TD 患者相比，诊断为 TD 的患者表现出更高的医疗保健利用率和费用。
这项研究由 Teva 制药公司（以色列佩塔提克瓦）资助。Truven Health Analytics，一家 IBM Watson Health 公司，因这项研究中的分析而从 Teva 制药公司获得报酬。Carroll 受雇于 Teva 制药公司，Irwin 受雇于 Truven Health Analytics，一家 IBM Watson Health 公司。
