Real-World Patterns of Utilization and Costs Associated with Second-Generation Oral Antipsychotic Medication for the Treatment of Bipolar Disorder: A Literature Review.
| Title: | Real-World Patterns of Utilization and Costs Associated with Second-Generation Oral Antipsychotic Medication for the Treatment of Bipolar Disorder: A Literature Review. |
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| Authors: | Doane MJ; Health Economics and Outcomes Research, Alkermes, Inc., Waltham, MA, USA.; Ogden K; Evidence, Worldwide Clinical Trials, Morrisville, NC, USA.; Bessonova L; Health Economics and Outcomes Research, Alkermes, Inc., Waltham, MA, USA.; O'Sullivan AK; Health Economics and Outcomes Research, Alkermes, Inc., Waltham, MA, USA.; Tohen M; Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, USA. |
| Source: | Neuropsychiatric disease and treatment [Neuropsychiatr Dis Treat] 2021 Feb 16; Vol. 17, pp. 515-531. Date of Electronic Publication: 2021 Feb 16 (Print Publication: 2021). |
| Publication Type: | Journal Article; Review |
| Language: | English |
| Journal Info: | Publisher: Dove Medical Press Country of Publication: New Zealand NLM ID: 101240304 Publication Model: eCollection Cited Medium: Print ISSN: 1176-6328 (Print) Linking ISSN: 11766328 NLM ISO Abbreviation: Neuropsychiatr Dis Treat Subsets: PubMed not MEDLINE |
| Imprint Name(s): | Original Publication: Albany, Auckland, N.Z. : Dove Medical Press, c2005- |
| Abstract: | Objective: Treatment with second-generation antipsychotics (SGAs) for bipolar disorder, including bipolar I disorder (BD-I), is common. This review evaluated real-world utilization patterns with oral SGAs in the United States (US) for bipolar disorder (and BD-I specifically when reported) and economic burden associated with these patterns.; Methods: Structured, systematic searches of MEDLINE®, EMBASE®, and National Health Service Economic Evaluation Database identified primary research studies (published 2008-2018) describing real-world SGA use in adults with bipolar disorder/BD-I.; Results: Among 769 studies screened, 39 met inclusion criteria. Most studies (72%) were analyses of commercial or Medicare/Medicaid claims databases. Patient-related (eg, demographic, comorbidities) and disease-related (eg, mania, psychosis) factors were associated with prescribed SGA. Suboptimal utilization patterns (ie, nonadherence, nonpersistence, treatment gaps, medication switching, and discontinuation) were common for patients treated with SGAs. Also common were SGAs prescribed with another psychotropic medication and SGA combination treatment (use of ≥2 SGAs concurrently). Suboptimal adherence and SGA combination treatment were both associated with increased health care resource use (HCRU); suboptimal adherence was associated with higher total direct medical and indirect costs.; Limitations: Different definitions for populations and concepts limited between-study comparisons. Focusing on SGAs limits contextualizing findings within the broader treatment landscape (eg, lithium, anticonvulsants). Given the nature of claims data, prescribing rationale (eg, acute episodes vs maintenance) and factors influencing observed utilization patterns could not be fully derived.; Conclusion: Despite increased use of SGAs to treat bipolar disorder over the last decade, reports of suboptimal utilization patterns of SGAs (eg, nonadherence, nonpersistence) were common as was combination treatment. Patterns of SGA use associated with additional HCRU and/or costs were suboptimal adherence and SGA combination treatment; economic consequences associated with other utilization patterns (eg, nonpersistence) were unclear. Strategies to improve SGA treatment continuity, particularly adherence, may improve clinical and economic outcomes among people living with bipolar disorder.; (© 2021 Doane et al.) |
| Competing Interests: | Leona Bessonova, Michael J. Doane, and Amy K. O’Sullivan are employees of Alkermes, Inc.; Leona Bessonova and Amy K. O’Sullivan may own stock/options in the company and Michael J. Doane owns Alkermes, Inc stock. Kristine Ogden is an employee of Worldwide Clinical Trials, Inc., which has received consulting fees from Alkermes, Inc. for conducting this study. Leona Bessonova reports personal fees from Alkermes Inc., outside the submitted work. Mauricio Tohen was an employee of Lilly (1997 to 2008) and has received honoraria from or consulted for Abbott, AstraZeneca, Alkermes, Allergan, Bristol-Myers Squibb, GlaxoSmithKline, Intracellular Therapies, Lilly, Johnson & Johnson, Otsuka, Merck, Gedeon Richter Plc, Sunovion, Forest, Roche, Elan, Lundbeck, Teva, Pamlab, Minerva, Neurocrine, Pfizer, Wyeth and Wiley Publishing; his spouse was a full time employee at Lilly (1998–2013). |
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| Contributed Indexing: | Keywords: adherence; antipsychotics; economics; mania; mood disorders; prescribing patterns; review |
| Entry Date(s): | Date Created: 20210224 Latest Revision: 20220420 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC7896797 |
| DOI: | 10.2147/NDT.S280051 |
| PMID: | 33623386 |
| Database: | MEDLINE |
Journal Article; Review