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.
Highlights
This 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
Bipolar disorder is a chronic, recurring disorder associated with periodic disruptions in mood regulation, with annual treatment costs of $7,200 to $12,100 per year, 20% of which are attributable to hospitalizations [1,2]
The objective of the current study was to assess the 1-year risk of psychiatric hospitalization and associated treatment costs in commercially insured patients with bipolar disorder newly treated with aripiprazole, ziprasidone, olanzapine, quetiapine or risperidone, alone or in combination with mood stabilizers
Summary
This 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. Despite the availability of multiple approved medication therapies, more than 75% of Medication treatment patterns are variable in the acute and long-term management of bipolar disorder, with 42-64% of patients receiving mood stabilizers, such as lithium, valproate or carbamazapine, and 44-60% receiving adjunctive antipsychotics [4,5,6]. Adjunctive mood stabilizer-atypical antipsychotic combination treatments may help to prevent psychiatric hospitalization in bipolar disorder [12]. In a recent commercial claims database study, adjunctive aripiprazole was found to be associated with a longer time to initial psychiatric hospitalization than ziprasidone, olanzapine, quetiapine and risperidone during the first 90 days following initiation [13]. A subsequent analysis found that total healthcare expenditures were lower for aripiprazole than ziprasidone, olanzapine and risperidone, and mental health expenditures were lower for aripiprazole than all comparators [14]
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