British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.
Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.
BMJ Open. 2023 Apr 19;13(4):e070680. doi: 10.1136/bmjopen-2022-070680.
Non-adherence to antipsychotics is the greatest obstacle to treating schizophrenia. We assessed the economic and clinical impacts of adherence to antipsychotics among people living with HIV/AIDS (PLWH) and schizophrenia in British Columbia, Canada.
A population-based cohort study in British Columbia, Canada.
Eligible PLWH were enrolled in the Seek and Treat for Optimal Prevention HIV/AIDS population-based cohort during 2001-2016, diagnosed with schizophrenia, on antipsychotics for ≥1 day, and followed for ≥1 year from schizophrenia diagnosis date or 1 January 2001, whichever occurred last.
A two-part model assessed the marginal effect of adherence on healthcare costs (in 2016 Canadian dollar), while logistic regression examined the effect on virological failure, and generalised linear mixed models examined the effect on hospital readmissions within 30 days and length of hospital stay.
Among 726 PLWH with schizophrenia, ≥80% adherence to antipsychotics increased from 25% (50/198) in 2001 to 41% (225/554) in 2016. In most years, we observed no difference in adherence to antipsychotics among those who used only injectables, only non-injectables, and a combination of both, or among those who have ever consumed typical/first-generation antipsychotics and who consumed only atypical/second-generation antipsychotics. Overall healthcare costs were higher in the non-adherent group ($C2185), driven by the average annual hospitalisation costs ($C5517), particularly among women ($C8806) and people who ever injected drugs (PWID) ($C5985). Non-adherent individuals also experienced higher hospital readmissions (adjusted odds ratio (aOR) 1.48, 95% CI 1.23 to 1.77), and longer hospital stays (adjusted mean ratio 1.23, 95% CI 1.13 to 1.35) in comparison to adherent individuals. We found no difference in virological failure by adherence groups, except when we stratified by gender where the aOR for women was 2.48 (95% CI 1.06 to 5.82).
Our results showed that implementing strategies and interventions to increase antipsychotic adherence, particularly among women and PWID, will be critical in addressing this public health challenge.
抗精神病药物依从性差是治疗精神分裂症的最大障碍。我们评估了加拿大不列颠哥伦比亚省艾滋病毒/艾滋病（PLWH）和精神分裂症患者抗精神病药物依从性对经济和临床的影响。
在加拿大不列颠哥伦比亚省进行的一项基于人群的队列研究。
2001-2016 年期间，在 Seek and Treat for Optimal Prevention HIV/AIDS 人群队列中纳入符合条件的 PLWH，诊断为精神分裂症，至少服用 1 天抗精神病药物，并从精神分裂症诊断日期或 2001 年 1 月 1 日（以最后发生的为准）起至少随访 1 年。
两部分模型评估了依从性对医疗保健成本（2016 年加拿大元）的边际影响，逻辑回归检验了对病毒学失败的影响，广义线性混合模型检验了对 30 天内住院再入院和住院时间的影响。
在 726 名患有精神分裂症的 PLWH 中，2001 年仅有 25%（50/198）的患者对抗精神病药物的依从性≥80%，而 2016 年这一比例增加到 41%（225/554）。在大多数年份，我们观察到仅使用注射剂、仅使用非注射剂或两者联合使用的患者，以及曾经使用过典型/第一代抗精神病药物和仅使用非典型/第二代抗精神病药物的患者之间，对抗精神病药物的依从性没有差异。非依从性组的整体医疗保健费用较高（C2185），主要是由于平均年度住院费用（C5517）较高，特别是女性（C8806）和曾经使用过注射药物的人（PWID）（C5985）。与依从性较好的个体相比，非依从性个体的住院再入院率更高（校正优势比（aOR）1.48，95%CI 1.23 至 1.77），住院时间更长（校正平均比 1.23，95%CI 1.13 至 1.35）。除了按性别分层时，女性的 aOR 为 2.48（95%CI 1.06 至 5.82）外，我们没有发现依从性组之间病毒学失败有差异。
我们的研究结果表明，实施提高抗精神病药物依从性的策略和干预措施，特别是针对女性和 PWID，对于解决这一公共卫生挑战至关重要。
