Systematic Review of Real-World Treatment Patterns of Oral Antipsychotics and Associated Economic Burden in Patients with Schizophrenia in the United States.
| Title: | Systematic Review of Real-World Treatment Patterns of Oral Antipsychotics and Associated Economic Burden in Patients with Schizophrenia in the United States. |
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| Authors: | Martin A; Evidera, 500 Totten Pond Road, Waltham, MA, 02451, USA.; Bessonova L; Alkermes, Inc, 852 Winter Street, Waltham, MA, 02451-1420, USA.; Hughes R; Evidera, 500 Totten Pond Road, Waltham, MA, 02451, USA.; Doane MJ; Alkermes, Inc, 852 Winter Street, Waltham, MA, 02451-1420, USA. michael.doane@alkermes.com.; O'Sullivan AK; Alkermes, Inc, 852 Winter Street, Waltham, MA, 02451-1420, USA.; Snook K; Evidera, 500 Totten Pond Road, Waltham, MA, 02451, USA.; Cichewicz A; Evidera, 500 Totten Pond Road, Waltham, MA, 02451, USA.; Weiden PJ; Alkermes, Inc, 852 Winter Street, Waltham, MA, 02451-1420, USA.; Harvey PD; University of Miami Miller School of Medicine, 1600 NW 10th Avenue, Miami, FL, 33136, USA. |
| Source: | Advances in therapy [Adv Ther] 2022 Sep; Vol. 39 (9), pp. 3933-3956. Date of Electronic Publication: 2022 Jul 18. |
| Publication Type: | Journal Article; Systematic Review |
| Language: | English |
| Journal Info: | Publisher: Health Communications Inc Country of Publication: United States NLM ID: 8611864 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1865-8652 (Electronic) Linking ISSN: 0741238X NLM ISO Abbreviation: Adv Ther |
| Imprint Name(s): | Publication: New York : Springer Healthcare Communications, 2008- : Health Communications Inc.; Original Publication: Metuchen, N.J. : Health Communications Inc., c1984- |
| MeSH Terms: | Schizophrenia*/drug therapy ; Antipsychotic Agents*; Olanzapine/therapeutic use ; Quetiapine Fumarate/therapeutic use ; Risperidone/therapeutic use ; Adult ; Financial Stress ; Humans ; 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. Mean annual direct medical costs differed by treatment, with reported costs of $17,115 to $26,138 for patients treated with olanzapine, $18,395 for risperidone, and $17,656 to $28,101 for quetiapine.; Limitations: This systematic review is limited by the variations in definitions of schizophrenia-related clinical terms used between studies and by the inclusion of studies focused on only the US health care system.; Conclusions: In the treatment of schizophrenia, suboptimal adherence, antipsychotic switching, and antipsychotic augmentation were all associated with high costs of care in comparison to patients who were adherent and did not require antipsychotic switching or augmentation. These findings illustrate the need for the development of new treatments that address efficacy and adherence challenges of currently available therapies.; (© 2022. The Author(s).) |
| References: | Psychiatr Serv. 2014 Feb 1;65(2):186-92. (PMID: 24233347); J Comp Eff Res. 2015 Nov;4(6):579-92. (PMID: 26168935); Am J Manag Care. 2014 Feb 01;20(2):e52-60. (PMID: 24738555); Schizophr Res. 2011 Sep;131(1-3):127-32. (PMID: 21576008); Psychiatry Res. 2008 Jan 15;157(1-3):259-63. (PMID: 17935793); Psychol Med. 2006 Nov;36(11):1535-40. (PMID: 16907994); BMC Psychiatry. 2014 Nov 30;14:341. (PMID: 25433495); J Clin Psychiatry. 2016 Jun;77(6):764-71. (PMID: 27135986); Am J Psychiatry. 2016 Feb 1;173(2):166-73. (PMID: 26541815); BMC Psychiatry. 2012 Aug 02;12:99. (PMID: 22856540); J Manag Care Spec Pharm. 2014 Jul;20(7):756-66. (PMID: 24967528); BMC Psychiatry. 2017 Jun 2;17(1):207. (PMID: 28576133); Value Health. 2008 Jan-Feb;11(1):34-43. (PMID: 18237358); Psychiatr Serv. 2015 Feb 1;66(2):127-33. (PMID: 25321616); N Engl J Med. 2005 Sep 22;353(12):1209-23. (PMID: 16172203); BMC Psychiatry. 2009 Jul 29;9:46. (PMID: 19640279); Am J Psychiatry. 1995 Jun;152(6):856-61. (PMID: 7755114); Am J Health Syst Pharm. 2015 Mar 1;72(5):378-89. (PMID: 25694413); Int J Clin Pract. 2012 Jun;66(6):565-73. (PMID: 22574724); Drugs Real World Outcomes. 2018 Mar;5(1):81-90. (PMID: 29363022); J Manag Care Spec Pharm. 2015 Sep;21(9):754-68. (PMID: 26308223); J Pharm Health Serv Res. 2013 Mar;4(1):29-39. (PMID: 23486693); PLoS Med. 2009 Jul 21;6(7):e1000097. (PMID: 19621072); Arch Gen Psychiatry. 1993 Feb;50(2):85-94. (PMID: 8427558); Ann Pharmacother. 2009 Jan;43(1):36-44. (PMID: 19126828); J Clin Psychiatry. 2009;70 Suppl 4:1-46; quiz 47-8. (PMID: 19686636); Curr Med Res Opin. 2017 May;33(5):813-820. (PMID: 28098496); Psychiatr Serv. 2010 Dec;61(12):1239-47. (PMID: 21123409); Community Ment Health J. 2008 Oct;44(5):377-80. (PMID: 18465228); Schizophr Bull. 1995;21(3):419-29. (PMID: 7481573); Psychiatr Q. 2009 Dec;80(4):241-9. (PMID: 19768543); Acta Psychiatr Scand. 2014 Jul;130(1):30-9. (PMID: 24299466); Curr Med Res Opin. 2009 Mar;25(3):755-64. (PMID: 19199435); Adv Ther. 2013 Mar;30(3):286-97. (PMID: 23483449); Clinicoecon Outcomes Res. 2018 Jun 08;10:309-320. (PMID: 29922078); Schizophr Res. 2009 Dec;115(2-3):115-20. (PMID: 19864113); Adm Policy Ment Health. 2014 Sep;41(5):598-607. (PMID: 23733044); J Manag Care Spec Pharm. 2016 Nov;22(11):1349-1361. (PMID: 27783548); JAMA Psychiatry. 2015 Dec;72(12):1172-81. (PMID: 26509694); Schizophr Bull. 2013 Sep;39(5):1159-68. (PMID: 23112292); Value Health. 2008 May-Jun;11(3):487-96. (PMID: 18489672); BMC Psychiatry. 2009 Sep 02;9:54. (PMID: 19725969); J Clin Psychiatry. 2008 Jan;69(1):47-53. (PMID: 18312037); J Manag Care Spec Pharm. 2015 Sep;21(9):780-92. (PMID: 26308225); BMC Psychiatry. 2008 Apr 04;8:19. (PMID: 18394168); Med Care. 2010 May;48(5):440-7. (PMID: 20351586); J Clin Psychiatry. 2016;77(suppl 3):1-24. (PMID: 27732772); Value Health. 2009 Sep;12(6):989-95. (PMID: 19402852); Schizophrenia (Heidelb). 2022 Feb 24;8(1):5. (PMID: 35210430); BMC Psychiatry. 2012 Dec 05;12:222. (PMID: 23216976); Manag Care. 2015 Nov;24(11):58-64. (PMID: 26672173); Biol Psychiatry. 2005 Oct 15;58(8):668-76. (PMID: 16023620); Ann Clin Psychiatry. 2015 May;27(2):90-9. (PMID: 25696785); J Med Econ. 2018 Dec;21(12):1221-1229. (PMID: 30238806); Psychiatr Serv. 2009 Feb;60(2):175-82. (PMID: 19176410); J Clin Psychiatry. 2012 Apr;73(4):498-503. (PMID: 22226332); Schizophr Res. 2008 Jan;98(1-3):8-15. (PMID: 17596914); Clin Ther. 2017 Oct;39(10):1972-1985.e2. (PMID: 28919292); Value Health. 2009 Jul-Aug;12(5):708-15. (PMID: 19508658); Community Ment Health J. 2013 Dec;49(6):625-9. (PMID: 23934237); J Clin Psychopharmacol. 2008 Feb;28(1):74-7. (PMID: 18204345); Psychiatr Serv. 2013 Mar 1;64(3):230-7. (PMID: 23242347); Psychiatr Serv. 2017 Jun 1;68(6):579-586. (PMID: 28196460); J Clin Psychiatry. 2016 Oct;77(10):e1332-e1341. (PMID: 27574835); Psychiatr Serv. 2012 Nov;63(11):1146-9. (PMID: 23117514); J Med Econ. 2012;15(1):105-11. (PMID: 21991926); BMC Psychiatry. 2017 Oct 18;17(1):346. (PMID: 29047368); Drugs Real World Outcomes. 2015;2(4):377-385. (PMID: 26689953); Am J Psychiatry. 2004 Apr;161(4):692-9. (PMID: 15056516); BMC Psychiatry. 2010 Jan 07;10:2. (PMID: 20059765); Lancet. 2019 Sep 14;394(10202):939-951. (PMID: 31303314); Curr Med Res Opin. 2018 Aug;34(8):1377-1388. (PMID: 29452492); J Med Econ. 2018 Feb;21(2):127-134. (PMID: 28895758); Curr Med Res Opin. 2017 Apr;33(4):723-731. (PMID: 28044455); Prim Care Companion CNS Disord. 2012;14(3):. (PMID: 23106028); J Med Econ. 2015 May;18(5):357-65. (PMID: 25525771) |
| Contributed Indexing: | Keywords: Antipsychotics; Costs; Mental health; Standard of care; Treatment adherence; Local Abstract: [plain-language-summary] Schizophrenia is a debilitating mental disorder that affects up to 1.6% of adults in the USA. Antipsychotic medications reduce symptoms of the disease, but many patients with schizophrenia are not fully adherent or choose to discontinue treatment entirely, increasing their risk of hospitalization. In others, efforts to achieve better symptom control or to avoid intolerable side effects may result in switching antipsychotic medications or adding additional medications, leading to higher medical treatment costs. The magnitude of these cost increases is unclear. This study sought to assess medical costs associated with antipsychotic treatment adherence, switching, and adding additional antipsychotics. We reviewed 81 studies published from January 2008 through June 2018 examining treatment adherence in patients with schizophrenia. We calculated rates of adherence, switching, and adding antipsychotics, as well as associated medical costs. Overall adherence to antipsychotic treatment was less than 50%, with up to 50% of patients switching medications and up to 29% adding an additional antipsychotic medication to their current treatment. Patients who were not treatment adherent incurred annual medical costs of $10,316 compared with $5723 in patients who were adherent. The costs of immediate or delayed switching of antipsychotic medications ranged from $21,922 to $28,232, while costs of adding an additional antipsychotic ranged from $24,045 to $29,344. These data suggest that suboptimal medication adherence, along with high rates of patient discontinuation and medication switching, lead to higher treatment costs in the management of patients with schizophrenia. |
| Substance Nomenclature: | 0 (Antipsychotic Agents); 2S3PL1B6UJ (Quetiapine Fumarate); L6UH7ZF8HC (Risperidone); N7U69T4SZR (Olanzapine) |
| Entry Date(s): | Date Created: 20220717 Date Completed: 20220826 Latest Revision: 20251031 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC9402774 |
| DOI: | 10.1007/s12325-022-02232-z |
| PMID: | 35844007 |
| Database: | MEDLINE |
Journal Article; Systematic Review