PDG45 LOW-VALUE CARE: THE ASSOCIATION OF ANTIPSYCHOTIC POLYPHARMACY USE TO ECONOMIC BURDEN IN NON-INSTITUTIONALIZED CIVILIAN POPULATION IN THE UNITED STATES

Abstract

Antipsychotic polypharmacy (APP) use, the concurrent use of two or more antipsychotic medications, is considered low value care. However, the association of this low-value care to healthcare expenditure is unknown. The objective of this study was to assess the association of low-value care (i.e. APP use) and healthcare expenditures among non-institutionalized adults in the United States. We adopted a retrospective longitudinal design with panel data (panels 13-19; years 2008 through 2015; one year baseline and one year follow-up) from the Medical Expenditure Panel Survey (MEPS). We included adults (> 18 years) with least one antipsychotic medication in the baseline period and were observed during both baseline and follow-up periods (N = 968). Individuals who used at least two different antipsychotic medications during the baseline period were defined as APP users. Expenditures were measured during the follow-up period. Unadjusted and adjusted models were built using Generalized Linear Models with gamma distribution and log-link for expenditures. Adjusted models were controlled for patient-level demographic-, socio-economic-, health- status, access to care, and lifestyle practices during the baseline. All analyses accounted for complex survey design of the MEPS. APP use was identified in 11.7% of adults who used at least one antipsychotic medication. APP users had higher total expenditures ($11,912 vs. $8,996) compared to no APP users. Adjusted follow-up period total ($13,467 vs. $9962; P=.01), third-party ($9,077 vs. $6,735; P=.02) and out-of-pocket ($6,719 vs. $4276; P=.03) expenditures were higher among APP users compared to those who did not have APP use. In this first population-based study, APP use was significantly associated with higher healthcare expenditures. Future research is needed to capture additional evidence that can improve the optimization of programs to avoid APP and better management of mental diseases for patients who use antipsychotic medications.