Real-World Patterns of Utilization and Costs Associated with Second-Generation Oral Antipsychotic Medication for the Treatment of Bipolar Disorder: A Literature Review
Open Access
- 1 February 2021
- journal article
- review article
- Published by Taylor & Francis Ltd in Neuropsychiatric Disease and Treatment
- Vol. ume 17, 515-531
- https://doi.org/10.2147/ndt.s280051
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.Keywords
This publication has 55 references indexed in Scilit:
- Patterns of atypical antipsychotic therapy use in adults with bipolar I disorder in the USAHuman Psychopharmacology: Clinical and Experimental, 2013
- Factors Associated with the Prescribing of Olanzapine, Quetiapine, and Risperidone in Patients with Bipolar and Related Affective DisordersPharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 2011
- Prevalence and Correlates of Bipolar Spectrum Disorder in the World Mental Health Survey InitiativeArchives of General Psychiatry, 2011
- One-year risk of psychiatric hospitalization and associated treatment costs in bipolar disorder treated with atypical antipsychotics: a retrospective claims database analysisBMC Psychiatry, 2011
- Description of Study Population and Analysis of Factors Influencing Adherence in the Observational Italian Study “Evaluation of Pharmacotherapy Adherence in Bipolar Disorder” (EPHAR)CNS Neuroscience & Therapeutics, 2010
- Safety and Tolerability Associated With Second-Generation Antipsychotic Polytherapy in Bipolar DisorderPublished by Physicians Postgraduate Press, Inc ,2010
- Clinical Features Associated With Poor Pharmacologic Adherence in Bipolar DisorderBritish Journal of Psychology, 2010
- Predictors of nonadherence among individuals with bipolar disorder receiving treatment in a community mental health clinicComprehensive Psychiatry, 2009
- The relationship between antipsychotic medication adherence and patient outcomes among individuals diagnosed with bipolar disorder: a retrospective studyAnnals of General Psychiatry, 2009
- Prescription Patterns of Psychotropic Medications in Elderly Compared With Younger Participants Who Achieved a “Recovered” Status in the Systematic Treatment Enhancement Program for Bipolar DisorderAmerican Journal of Geriatric Psychiatry, 2008