Abstract
BackgroundSwitching between antipsychotic medications is common in the treatment of schizophrenia. However, data on clinical and economic outcomes from antipsychotic switching, in particular acute care service use, is fairly limited. The goal of this research was to assess the clinical and economic ramifications of switching antipsychotics during outpatient management of schizophrenia.MethodsData from a 1-year randomized, open-label cost-effectiveness study involving typical and atypical antipsychotics were assessed. The study protocol permitted switching of antipsychotics when clinically warranted. The risk of crisis-related events, use of acute-care services, and the time to the initial use of such services were determined in outpatients who switched antipsychotics compared with those who continued with their initial medications. Health care resource utilization data were abstracted from medical records and other sources (e.g., patient self-report), and direct costs were estimated using previously published benchmarks.ResultsAlmost one-third of patients (29.3%) underwent a switch from their initial antipsychotic agent, with an average duration of 100 days before such treatment alterations. Compared with their counterparts who remained on their initial therapies, individuals who switched antipsychotics experienced a significantly higher risk of acute-care services, including hospitalization (p = .013) and crisis services (p = .011). Patients undergoing medication switches also used acute-care services significantly sooner (p = .004) and accrued an additional $3,000 (a 25% increase) in annual total health care costs per patient, most of which was due to acute-care expenditures.ConclusionSwitching antipsychotic medications was found to be associated with considerably poorer clinical and economic outcomes, as reflected by, more frequent and more rapid use of acute-care services compared with persons remaining on their initial treatments.Trial RegistrationTrial ID 2325 in LillyTrials.com (also accessible via ClinicalStudyResults.org).
Highlights
Switching between antipsychotic medications is common in the treatment of schizophrenia
Protocol and consent documents were approved by a central institutional review board (IRB) or by local IRBs, and signed consent forms were obtained from patients prior to participation
Reasons for medication switching were not obtained for 28.2% of switchers, with the rest evenly divided between patient request (26.3%), lack of efficacy (23.1%), and adverse events (22.4%)
Summary
Switching between antipsychotic medications is common in the treatment of schizophrenia. Antipsychotic medications are mainstays in the management of schizophrenia, yet many patients experience suboptimal improvement (or even worsening) in the core symptoms of their disease or intolerance to their initially prescribed treatments [1,2,3] Under such conditions, a clinically indicated change (i.e., switch) in antipsychotics represents a viable treatment option, and such alterations are not uncommon among patients with schizophrenia [3,4,5,6,7,8,9,10,11]. Data on the clinical and economic ramifications of antipsychotic switching, the use of acute-care services and the time to the first use of such services, are limited. Such information is especially relevant for policy makers and other mental health decision makers. We assessed the baseline characteristics of persons who switch medications and their treatment patterns before and following the medication switch
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