One-year risk of psychiatric hospitalization and associated treatment costs in bipolar disorder treated with atypical antipsychotics: a retrospective claims database analysis

Abstract

BackgroundThis study compared 1-year risk of psychiatric hospitalization and treatment costs in commercially insured patients with bipolar disorder, treated with aripiprazole, ziprasidone, olanzapine, quetiapine or risperidone.MethodsThis was a retrospective propensity score-matched cohort study using the Ingenix Lab/Rx integrated insurance claims dataset. Patients with bipolar disorder and 180 days of pre-index enrollment without antipsychotic exposure who received atypical antipsychotic agents were followed for up to 12 months following the initial antipsychotic prescription. The primary analysis used Cox proportional hazards regression to evaluate time-dependent risk of hospitalization, adjusting for age, sex and pre-index hospitalization. Generalized gamma regression compared post-index costs between treatment groups.ResultsCompared to aripiprazole, ziprasidone, olanzapine and quetiapine had higher risks for hospitalization (hazard ratio 1.96, 1.55 and 1.56, respectively; p < 0.05); risperidone had a numerically higher but not statistically different risk (hazard ratio 1.37; p = 0.10). Mental health treatment costs were significantly lower for aripiprazole compared with ziprasidone (p = 0.004) and quetiapine (p = 0.007), but not compared to olanzapine (p = 0.29) or risperidone (p = 0.80). Total healthcare costs were significantly lower for aripiprazole compared to quetiapine (p = 0.040) but not other comparators.ConclusionsIn commercially insured adults with bipolar disorder followed for 1 year after initiation of atypical antipsychotics, treatment with aripiprazole was associated with a lower risk of psychiatric hospitalization than ziprasidone, quetiapine, olanzapine and risperidone, although this did not reach significance with the latter. Aripiprazole was also associated with significantly lower total healthcare costs than quetiapine, but not the other comparators.

Impact of initiation of asenapine on patterns of utilization and cost of healthcare resources associated with the treatment of bipolar I disorder

“…Among the former, atypical antipsychotics (AAPs) have been increasingly used in recent years, mainly due to low rates of extra-pyramidal symptoms (some AAPs have dose dependent relationship), negative symptoms (e.g., lack of emotion, interest, and/or expression) 10 , and conditions such as tardive dyskinesia, as compared to conventional (typical) antipsychotics 1 , with evidence of efficacy as well as effectiveness in treating BPD 11,12 . AAPs have been reported to lower the rate of hospital admissions and emergency room visits, and also decrease total all-cause and mental health-related medical costs in patients with BPD [13][14][15][16] . For instance, the mean per patient reduction in costs for all-cause and mental health-related services was $1395 and $1038, respectively, for aripiprazole 16 relatively new AAP that was approved by the US Food and Drug Administration in 2009 for the treatment of BPD.…”

Comprehensive comparison of monotherapies for psychiatric hospitalization risk in bipolar disorders

“…Previous studies comparing the effectiveness of BD acute-phase and maintenance treatment with valproate versus lithium (as monotherapies or adjuncts) showed contradictory results. 2,[16][17][18][19] Aripiprazole has been consistently reported to have the most favorable hospitalization outcomes among SGAs in retrospective studies, 1,13,20,21 whereas a recent review of BD randomized controlled trials on adjunctive antipsychotics showed only one study with an SGA superior to lithium, namely quetiapine. 22 The literature on bupropion suggests that it has equivalent effectiveness to other ADs in treatment of depressive states, [23][24][25] with contradictory data on manic switch risk.…”

“…Hospitalization in bipolar disorder (BD) is a high-incidence outcome of great clinical and socioeconomic importance. 1 Hospital admission due to a severe mood episode occurs in 17%-40% of patients within the first year following BD acute phase treatment, 2 in 50% of patients within 4 years, 3 and in 79% of patients within 15 years. 4 The evidence on drug-dependent risk of hospitalization in BD is incomplete and contradictory.…”

New approaches for the management of bipolar disorder: role of sublingual asenapine in the treatment of mania

“…All antipsychotic drugs that have been studied have been found to be effective for mania,32–34 and atypical antipsychotic drugs have been promoted widely for maintenance therapy. However, randomized trials supporting this application have involved patients with uncomplicated mood disorders without the kind of comorbidity that is common in actual practice 35.…”