Health Care Practice, Analysis Group, Inc, Boston, MA, USA.
Health Care Practice, Analysis Group, Inc, New York, NY, USA.
J Med Econ. 2020 Feb;23(2):204-212. doi: 10.1080/13696998.2019.1685818. Epub 2019 Nov 26.
To evaluate the association of relapse and healthcare resource utilization in patients with schizophrenia (SZ), bipolar disorder (BD), or major depressive disorder (MDD) who switched antipsychotic medication versus those who did not. Medicaid claims from six US states spanning six years were retrospectively analyzed for antipsychotic switching versus non-switching. For all patients with SZ, BD, or MDD, and for the subset of patients who also had ≥1 extrapyramidal symptoms (EPS) diagnosis at baseline, times to the following outcomes were analyzed: underlying disease relapse, other psychiatric relapse, all-cause emergency room (ER) visit, all-cause inpatient (IP) admission, and EPS diagnosis. Switchers ( = 10,548) had a shorter time to disease relapse, other psychiatric relapse, IP admissions, ER visits, and EPS diagnosis (all, log-rank < .001) than non-switchers ( = 31,644). Switchers reached the median for IP admission (21.50 months) vs non-switchers (not reached) and for ER visits (switchers, 9.07 months; non-switchers, 13.35 months). For disease relapse, other psychiatric relapse, and EPS diagnosis, <50% of patients had an event during the two-year study period. Subgroup analysis of those with ≥1 EPS diagnosis revealed similar associations. Only association, not causation, may be inferred, and there may be differences between the patient groups in parameters not evaluated. These results show that disease and other psychiatric relapse, all-cause ER visits, IP admissions, and EPS diagnosis occurred earlier for patients who switched antipsychotics than for those who did not, suggesting that switching is associated with an increased risk of relapse in patients with SZ, BD, and MDD. This may be attributed to more-severely ill patients being less responsive than those with less-severe illness, which, in turn, may require more episodes of switching.
评估精神分裂症（SZ）、双相情感障碍（BD）或重度抑郁症（MDD）患者在抗精神病药物转换与不转换之间疾病复发和医疗资源利用的相关性。对六个美国州为期六年的医疗补助索赔进行回顾性分析，以评估抗精神病药物转换与不转换。对于所有 SZ、BD 或 MDD 患者，以及基线时至少有 1 个锥体外系症状（EPS）诊断的患者亚组，分析了以下结局的时间：基础疾病复发、其他精神疾病复发、全因急诊室（ER）就诊、全因住院（IP）入院和 EPS 诊断。与非转换者（n=31644）相比，转换者（n=10548）疾病复发、其他精神疾病复发、IP 入院、ER 就诊和 EPS 诊断的时间更短（所有 log-rank <0.001）。转换者达到 IP 入院（21.50 个月）和 ER 就诊（转换者，9.07 个月；非转换者，13.35 个月）中位数的时间短于非转换者（未达到）。对于疾病复发、其他精神疾病复发和 EPS 诊断，<50%的患者在两年研究期间发生了事件。≥1 个 EPS 诊断患者亚组分析显示了类似的相关性。只能推断出关联，而不是因果关系，并且在未评估的参数之间，患者群体可能存在差异。这些结果表明，与未转换者相比，转换抗精神病药物的患者疾病和其他精神疾病复发、全因 ER 就诊、IP 入院和 EPS 诊断发生得更早，这表明转换与 SZ、BD 和 MDD 患者的复发风险增加有关。这可能归因于病情较重的患者比病情较轻的患者反应较差，这反过来可能需要更多次的转换。
