Real-World Patterns of Utilization and Costs Associated with Second-Generation Oral Antipsychotic Medication for the Treatment of Bipolar Disorder: A Literature Review

Michael J Doane,1 Kristine Ogden,2 Leona Bessonova,1 Amy K O’Sullivan,1 Mauricio Tohen3 1Health Economics and Outcomes Research, Alkermes, Inc., Waltham, MA, USA; 2Evidence, Worldwide Clinical Trials, Morrisville, NC, USA; 3Department of Psychiatry and Behavioral Sciences, University of Ne...

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Autores principales:	Doane MJ, Ogden K, Bessonova L, O'Sullivan AK, Tohen M
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	adherence antipsychotics economics mania mood disorders prescribing patterns review Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/a2fd04ce5bca4ad38f3f36cba136f6c2
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spelling	oai:doaj.org-article:a2fd04ce5bca4ad38f3f36cba136f6c22021-12-02T10:52:16ZReal-World Patterns of Utilization and Costs Associated with Second-Generation Oral Antipsychotic Medication for the Treatment of Bipolar Disorder: A Literature Review1178-2021https://doaj.org/article/a2fd04ce5bca4ad38f3f36cba136f6c22021-02-01T00:00:00Zhttps://www.dovepress.com/real-world-patterns-of-utilization-and-costs-associated-with-second-ge-peer-reviewed-article-NDThttps://doaj.org/toc/1178-2021Michael J Doane,1 Kristine Ogden,2 Leona Bessonova,1 Amy K O’Sullivan,1 Mauricio Tohen3 1Health Economics and Outcomes Research, Alkermes, Inc., Waltham, MA, USA; 2Evidence, Worldwide Clinical Trials, Morrisville, NC, USA; 3Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, USACorrespondence: Leona BessonovaHealth Economics and Outcomes Research, Alkermes, Inc., 852 Winter Street, Waltham, MA, 02451-1420, USATel +1 781 609 6439Email leona.bessonova@alkermes.comObjective: 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: adherence, antipsychotics, economics, mania, mood disorders, prescribing patterns, reviewDoane MJOgden KBessonova LO'Sullivan AKTohen MDove Medical Pressarticleadherenceantipsychoticseconomicsmaniamood disordersprescribing patternsreviewNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol Volume 17, Pp 515-531 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	adherence antipsychotics economics mania mood disorders prescribing patterns review Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	adherence antipsychotics economics mania mood disorders prescribing patterns review Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Doane MJ Ogden K Bessonova L O'Sullivan AK Tohen M Real-World Patterns of Utilization and Costs Associated with Second-Generation Oral Antipsychotic Medication for the Treatment of Bipolar Disorder: A Literature Review
description	Michael J Doane,1 Kristine Ogden,2 Leona Bessonova,1 Amy K O’Sullivan,1 Mauricio Tohen3 1Health Economics and Outcomes Research, Alkermes, Inc., Waltham, MA, USA; 2Evidence, Worldwide Clinical Trials, Morrisville, NC, USA; 3Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, USACorrespondence: Leona BessonovaHealth Economics and Outcomes Research, Alkermes, Inc., 852 Winter Street, Waltham, MA, 02451-1420, USATel +1 781 609 6439Email leona.bessonova@alkermes.comObjective: 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: adherence, antipsychotics, economics, mania, mood disorders, prescribing patterns, review
format	article
author	Doane MJ Ogden K Bessonova L O'Sullivan AK Tohen M
author_facet	Doane MJ Ogden K Bessonova L O'Sullivan AK Tohen M
author_sort	Doane MJ
title	Real-World Patterns of Utilization and Costs Associated with Second-Generation Oral Antipsychotic Medication for the Treatment of Bipolar Disorder: A Literature Review
title_short	Real-World Patterns of Utilization and Costs Associated with Second-Generation Oral Antipsychotic Medication for the Treatment of Bipolar Disorder: A Literature Review
title_full	Real-World Patterns of Utilization and Costs Associated with Second-Generation Oral Antipsychotic Medication for the Treatment of Bipolar Disorder: A Literature Review
title_fullStr	Real-World Patterns of Utilization and Costs Associated with Second-Generation Oral Antipsychotic Medication for the Treatment of Bipolar Disorder: A Literature Review
title_full_unstemmed	Real-World Patterns of Utilization and Costs Associated with Second-Generation Oral Antipsychotic Medication for the Treatment of Bipolar Disorder: A Literature Review
title_sort	real-world patterns of utilization and costs associated with second-generation oral antipsychotic medication for the treatment of bipolar disorder: a literature review
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/a2fd04ce5bca4ad38f3f36cba136f6c2
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Real-World Patterns of Utilization and Costs Associated with Second-Generation Oral Antipsychotic Medication for the Treatment of Bipolar Disorder: A Literature Review

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