Correlates of psychopharmacologic treatment outcomes for schizophrenia
Abstract
Schizophrenia is a severe and persistent mental illness that affects upwards of two million Americans and its treatment is estimated to cost {dollar}32 billion annually. Although pharmacotherapy represents the mainstay of treatment for schizophrenia, recent pharmacoepidemiologic data on practice patterns in large U.S. populations are limited. To address this need, a study was conducted with the following aims: (1) to characterize the patterns of pharmacologic management of schizophrenia and its demographic and clinical correlates in typical clinical practice settings; (2) to develop analytic models to examine the associations between characteristics of drug therapy and outcomes; and (3) to look for evidence of behavioral toxicity of antipsychotic medications. The data from this study were derived from a patient survey supplemented with medical record information of 719 participants recruited from inpatient and outpatient psychiatric facilities in two states for the Schizophrenia Patient Outcomes Research Team (PORT) study. The final study samples consisted of 224 inpatients and 358 outpatients that met eligibility criteria and had valid medical record data. Ethnic disparities in prescribing were identified, such that non-white patients received fewer newer antipsychotic medications, more long-acting injectable (depot) antipsychotic medications, higher average daily antipsychotic doses, and fewer adjunctive medications than their white counterparts, regardless of treatment setting. Geographic variations in prescribing patterns, in which newer antipsychotics and adjunctive medications (inpatients only) were prescribed more frequently in rural areas of State A and in urban areas of State B, and depot antipsychotics were prescribed more often in urban areas of State A and rural areas of State B, were also noted. The hypothesized model of an indirect relationship among pharmacotherapy and outcomes variables (functioning and satisfaction) that is mediated by symptoms and medication side effects was not supported by the data in either treatment setting. Also, evidence of behavioral toxicity of antipsychotics was not identified. Pronounced variations in the pharmacologic management of schizophrenia were revealed. Investigations of the outcomes of pharmacotherapy and the behavioral toxicity of antipsychotic medications should be undertaken, utilizing different measurement scales and a prospective, longitudinal study design.Description
University of Maryland, Baltimore. Pharmacy Administration. Ph.D. 1999Keyword
Health Sciences, Mental HealthHealth Sciences, Pharmacy
Health Sciences, Public Health
Psychology, Clinical
Antipsychotic Agents
Schizophrenia--drug therapy
Identifier to cite or link to this item
http://hdl.handle.net/10713/1240Related items
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Costs, outcomes and estimation of the cost-effectiveness of abciximab in the prevention of ischemic events over six months of follow-upAbciximab is an antiplatelet inhibitor used in conjunction with percutaneous revascularization procedures to decrease the risk of ischemic complications such as death, nonfatal MI or subsequent revascularization procedures like angioplasty or CABG. Although the efficacy of abciximab is rarely disputed based on evidence from three large clinical trials, the cost-effectiveness of the drug when used during routine practice has been questioned since it costs approximately $1,350 per patient treated. This study was undertaken to estimate the effectiveness of abciximab in patients treated at University of Maryland Medical System (UMMS) and to estimate the incremental cost-effectiveness ratio (ICER) defined as the cost per event avoided. The composite endpoint consisted of death, MI or subsequent revascularization procedure over 6-months of follow-up. Proportional hazards regression revealed that abciximab was associated with a lower risk of ischemic events among patients with more severe angiographic morphology. Patients who received a shortened infusion of the drug (<10 hours) were at a greater risk of experiencing an event than those who received an infusion for 10-14 hours. Also, patients who underwent coronary stenting were less likely to have an event while patients with multivessel disease or a history of a percutaneous revascularization procedure were at a higher risk of experiencing an event. The cost-effectiveness analysis was performed for a subgroup of patients with more severe coronary morphology using a matched cohort design. The point estimate of the ICER revealed that it cost about $20,680 to prevent an ischemic event over six months in high-risk patients treated with abciximab. Confidence intervals for the ICER were computed using Taylor series approximation, Fieller's theorem and bootstrapping, and were graphically represented with ellipses of equal probability. Overall, the data were consistent with a wide range of plausible estimates due to a relatively small denominator in the ICER.