Ng-Mak Daisy, Messali Andrew, Huang Ahong, Wang Li, Loebel Antony
Sunovion Pharmaceuticals, 84 Waterford Dr, Marlborough, MA 01752. Email:
Am J Manag Care. 2019 Jul;25(14 Suppl):S279-S286.
This study compared the risk of hospitalization among adults with schizophrenia being treated with equivalent dose ranges of lurasidone versus aripiprazole, olanzapine, quetiapine, or risperidone. Administrative claims data for this analysis came from the IBM MarketScan Commercial, Medicare Supplemental, and Multi-State Medicaid databases between January 2011 and June 2017. The study included adults with schizophrenia who initiated treatment with an antipsychotic and were continuously enrolled for 360 days prior to and following the date of the initial antipsychotic prescription. Risk of all-cause and schizophrenia-related hospitalization among patients who received lurasidone monotherapy versus aripiprazole, olanzapine, quetiapine, or risperidone in equivalent dose ranges were assessed. Marginal structural models that accounted for preindex characteristics, changes in antipsychotic treatment, and time-varying covariates assessed differences between lurasidone and other second-generation antipsychotics on all-cause and schizophrenia-related hospitalizations. A sensitivity analysis was conducted without the dose-equivalence requirement. A total of 20,212 patients met the study inclusion criteria. Compared with those treated with lurasidone monotherapy, the adjusted risk of all-cause hospitalization was significantly higher among patients treated with olanzapine (adjusted rate ratio [aRR], 1.49; P = .04), quetiapine (aRR, 1.64; P = .01), or risperidone (aRR, 1.47; P = .04), but not aripiprazole (aRR, 1.24; P = .28). A similar, non-statistically significant pattern of adjusted risks of schizophrenia-related hospitalizations was observed. A sensitivity analysis without the dose-equivalence requirement produced consistent results. As hospitalization is a major cost driver of direct healthcare cost, lurasidone may be a cost-saving treatment option for patients with schizophrenia.
本研究比较了接受等效剂量范围的鲁拉西酮与阿立哌唑、奥氮平、喹硫平或利培酮治疗的成年精神分裂症患者的住院风险。该分析的行政索赔数据来自2011年1月至2017年6月的IBM MarketScan商业、医疗保险补充和多州医疗补助数据库。该研究纳入了开始使用抗精神病药物治疗且在首次抗精神病药物处方日期之前和之后连续登记360天的成年精神分裂症患者。评估了接受鲁拉西酮单药治疗与接受等效剂量范围的阿立哌唑、奥氮平、喹硫平或利培酮治疗的患者的全因和精神分裂症相关住院风险。考虑了索引前特征、抗精神病药物治疗变化和随时间变化的协变量的边际结构模型评估了鲁拉西酮与其他第二代抗精神病药物在全因和精神分裂症相关住院方面的差异。在不要求剂量等效的情况下进行了敏感性分析。共有20212名患者符合研究纳入标准。与接受鲁拉西酮单药治疗的患者相比，接受奥氮平治疗的患者调整后的全因住院风险显著更高（调整率比[aRR]，1.49；P = 0.04），喹硫平（aRR，1.64；P = 0.01）或利培酮（aRR，1.47；P = 0.04），但阿立哌唑无显著差异（aRR，1.24；P = 0.28）。观察到精神分裂症相关住院调整风险的类似但无统计学意义的模式。不要求剂量等效的敏感性分析产生了一致的结果。由于住院是直接医疗费用的主要成本驱动因素，鲁拉西酮可能是精神分裂症患者节省成本的治疗选择。
