Systematic Review of Real-World Treatment Patterns of Oral Antipsychotics and Associated Economic Burden in Patients with Schizophrenia in the United States

Abstract

Background: Schizophrenia is a chronic mental disorder associated with substantial morbidity and mortality affecting 0.25-1.6% of adults in the USA. Antipsychotic treatment is the standard of care for schizophrenia, but real-world treatment patterns and associated costs have not been systematically reviewed. Objective: We conducted a systematic review to summarize treatment patterns and associated costs related to oral antipsychotic treatment of patients with schizophrenia in the USA. Data Sources: We searched Medline (via PubMed) and Embase to identify relevant observational studies published from January 1, 2008, to June 1, 2018; costs were converted to 2018 US dollars.Study Eligibility: Observational, real-world studies reporting on patterns of treatment and/ or associated costs for adult patients with schizophrenia treated with oral antipsychotics in the USA were included. Results: Eighty-one studies were identified. Frequently prescribed oral second-generation antipsychotics were olanzapine (up to 50.9%), risperidone (up to 40.0%), and quetiapine (up to 30.7%). Suboptimal adherence was common across studies. Antipsychotic switching occurred in about half of patients, while antipsychotic combination therapy occurred in nearly 30%; all were associated with increased medication-related costs.

Clinical Experience on the Use of a Single-day, Two-injection Start Initiation Regimen of Aripiprazole Once Monthly in Patients With Schizophrenia in Spain: SaTISfy Study

“… 19 Similarly, an observational study focused on the US population identified olanzapine, risperidone, and quetiapine as the most commonly prescribed antipsychotics for schizophrenia. 20 These results are consistent with a European study in which olanzapine and risperidone were reported to be the preferred choices, but according to that study, when the psychiatrists were asked about the medication they would prefer, significantly more would choose aripiprazole, considering the side effect profile a more important factor than efficacy. 21 According to many of the psychiatrists who took part in our study, aripiprazole was their first choice, as shown before in the 2EPS project (Clinical and neurobiological determinants of second episodes of schizophrenia.…”

“…According to an international cross-sectional study, the most commonly used antipsychotics in 2014 were quetiapine, risperidone, and olanzapine 19 . Similarly, an observational study focused on the US population identified olanzapine, risperidone, and quetiapine as the most commonly prescribed antipsychotics for schizophrenia 20 . These results are consistent with a European study in which olanzapine and risperidone were reported to be the preferred choices, but according to that study, when the psychiatrists were asked about the medication they would prefer, significantly more would choose aripiprazole, considering the side effect profile a more important factor than efficacy 21 .…”

Screening for High-Risk Human Papillomavirus Reveals HPV52 and HPV58 among Pediatric and Adult Patient Saliva Samples

“…Although most oral HPV infections are cleared between 18 and 24 months, clearance rates involving infection with high-risk oncogenic HPV strains, such as HPV52 and HPV58, may actually be much lower [ 51 , 52 ]. In addition, recent evidence has also shown that HPV clearance may be reduced by other comorbidities and treatments, including antipsychotic and antidepressant medications, which have been increasingly common prescriptions among Western industrialized countries [ 53 , 54 , 55 ]. Furthermore, although prevalence studies are lacking, two new studies from Hong Kong and the French West Indies have found that HPV52 may be the most commonly detected oral high-risk HPV strain (even among the control, non-cancer patient population), with oral prevalence ranging between 1.5% and 33% [ 56 , 57 ].…”

Inter-relationships of risk factors and pathways associated with all-cause mortality in patients with chronic schizophrenia

“…According to the Global Burden of Disease 2019, the raw prevalence, incidence, and burden of schizophrenia have increased since 1990, and no reduction has been observed in age-adjusted estimates ( 12 ). Regional studies in the United States, China, India, and South Korea have suggested a steady increase in the annual incidence of schizophrenia ( 13 – 15 ). In Taiwan, the 1-year prevalence rate of schizophrenia is 3.34 per 1,000 people, with a 6-year (cumulative) prevalence rate of 6.42 per 1,000 people from 1996 to 2001 ( 16 ).…”