Antipsychotic use in the elderly: shifting trends and increasing costs

Rapoport, Mark J.; Mamdani, Muhammad; Shulman, Kenneth I.; Herrmann, Nathan; Rochon, Paula A.

doi:10.1002/gps.1358

Cited by 65 publications

(46 citation statements)

References 24 publications

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“…3 In 2001, more than 70% of US atypical antipsychotic prescriptions were written for offlabel indications such as dementia, 4 and atypical antipsychotics accounted for 82% of antipsychotic prescriptions written for older patients in Canada in 2002. 5 Some pharmaceutical companies may have aided this growth by promoting the use of atypical antipsychotics for off-label purposes. 6 However, starting in 2002, worries began to arise about atypical antipsychotic safety including concerns about diabetes 7 and cerebrovascular events 8,9 (the latter emerging from randomized placebocontrolled trials of patients with dementia).…”

Section: Arch Gen Psychiatry 2011;68(2):190-197mentioning

confidence: 99%

Trends in Antipsychotic Use in Dementia 1999-2007

Kales¹,

Zivin²,

Kim³

et al. 2011

Arch Gen Psychiatry

159

148

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Section: Arch Gen Psychiatry 2011;68(2):190-197mentioning

confidence: 99%

Trends in Antipsychotic Use in Dementia 1999-2007

Kales¹,

Zivin²,

Kim³

et al. 2011

Arch Gen Psychiatry

159

148

View full text Add to dashboard Cite

show abstract

“…A Canadian study found that the prevalence of antipsychotic use in older adults increased from 2.2% in 1993 to 3.0% at the end of 2002. In that study, atypical antipsychotics, which were unavailable in 1993, accounted for 82.5% of all antipsychotics dispensed in 2002 (8). Short-term randomized, controlled trials (RCTs) have studied the role of atypical antipsychotics in the management of behavioral and psychological symptoms of dementia (2,9).…”

mentioning

confidence: 99%

Antipsychotic Drug Use and Mortality in Older Adults with Dementia

Gill

Bronskill²,

Normand³

et al. 2007

Ann Intern Med

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541

445

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“…Since the introduction of atypical antipsychotics, in the 1990s, the use of and costs associated with these drugs have increased substantially. [1][2][3][4][5][6] This increase has been driven primarily by prescriber preference for atypical (or second-generation) antipsychotics, 1,2 higher costs of newer agents compared with typical (or first-generation) antipsychotics 1 and a widening range of on-and off-label uses. [3][4][5][7][8][9] The increase in the use of atypical antipsychotic medications has been particularly marked in older adults with dementia.…”

mentioning

confidence: 99%

Trends in the use and cost of antipsychotics among older adults from 2007 to 2013: a repeated cross-sectional study

et al. 2016

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Background:Recently, several new atypical antipsychotic agents have been introduced in Ontario, and regulatory warnings have been issued regarding use of atypical antipsychotics in older adults. We sought to establish the impact of newer atypical antipsychotics on prescribing rates and costs. Methods:We performed a population-based cross-sectional study of Ontario adults aged 65 years or more using atypical antipsychotics from Jan. 1, 20071, , to Mar. 31, 2013. These people have universal access to publicly funded drugs through the Ontario Health Insurance Plan and the Ontario Drug Benefit. We conducted time-series analysis to assess the impact of the introduction of new atypical antipsychotics on rates of use of atypical antipsychotics and associated expenditures. Results:Rates of atypical antipsychotic use increased following the introduction of new agents in 2009, from 27.6 users per 1000 older adults in the third quarter of 2009 to 29.1 users per 1000 older adults at the end of the study period (p = 0.04). Although prescribing rates for the newer atypical agents (paliperidone, ziprasidone and aripiprazole) remained low relative to their older counterparts (risperidone, olanzapine and quetiapine), rates of aripiprazole use rose to 1.0 user per 1000 older adults by the end of the study period. The proportion of prescriptions that were for brand-name agents fell from 57.5% in the second quarter of 2007 to 6.1% in the second quarter of 2009, and then rose to 11.7% by the end of the study period. By the first quarter of 2013, newer atypical antipsychotic agents were used by 4.4% of atypical antipsychotic users but accounted for 14.1% ($1.2 million of $8.5 million) of atypical antipsychotic expenditures. Interpretation:Although the overall prevalence of use of new atypical antipsychotic agents remains low, their introduction has led to increased prescribing of this class of drugs in older adults. Given the potential cost implications, further study of these trends would be prudent. Abstract ResearchResearch CMAJ OPEN CMAJ OPEN 4(2) E293

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Antipsychotic use in the elderly: shifting trends and increasing costs

Cited by 65 publications

References 24 publications

Trends in Antipsychotic Use in Dementia 1999-2007

Trends in Antipsychotic Use in Dementia 1999-2007

Antipsychotic Drug Use and Mortality in Older Adults with Dementia

Trends in the use and cost of antipsychotics among older adults from 2007 to 2013: a repeated cross-sectional study

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