Comparison of health-related quality of life among patients using atypical antipsychotics for treatment of depression: results from the National Health and Wellness Survey.

BACKGROUND: Use of atypical antipsychotics (AA) in combination with an antidepressant is recommended as an augmentation strategy for patients with depression. However, there is a paucity of data comparing aripiprazole and other AAs in terms of patient reported outcomes. Therefore, the objective of this study was to examine the levels of HRQoL and health utility scores in patients with depression using aripiprazole compared with patients using olanzapine, quetiapine, risperidone and ziprasidone. METHODS: Data were obtained from the 2009, 2010, and 2011 National Health and Wellness Survey (NHWS), a cross-sectional, internet-based survey that is representative of the adult US population. Only those patients who reported being diagnosed with depression and taking an antidepressant and an atypical antipsychotic for depression were included. Patients taking an atypical antipsychotic for less than 2 months or who reported being diagnosed with bipolar disorder or schizophrenia were excluded. Patients taking aripiprazole were compared with patients taking other atypical antipsychotics. Health-related quality of life (HRQoL) and health utilities were assessed using the Short Form 12-item (SF-12) health survey. Differences between groups were analyzed using General Linear Models (GLM) controlling for demographic and health characteristics. RESULTS: Overall sample size was 426 with 59.9% taking aripiprazole (n=255) and 40.1% (n=171) taking another atypical antipsychotic (olanzapine (n=19), quetiapine (n=127), risperidone (n=14) or ziprasidone (n=11)). Of the SF-12 domains, mean mental component summary (MCS) score (p=.018), bodily pain (p=.047), general health (p=.009) and emotional role limitations (p=.009) were found to be significantly higher in aripiprazole users indicating better HRQoL compared to other atypical antipsychotics. After controlling for demographic and health characteristics, patients taking aripiprazole reported significantly higher mean mental SF-12 component summary (34.10 vs. 31.43, p=.018), bodily pain (55.19 vs. 49.05, p=.047), general health (50.05 vs. 43.07, p=.009), emotional role limitations (49.44 vs. 41.83, p=.009), and SF-6D utility scores (0.59 vs. 0.56, p=.042). CONCLUSIONS: Comparison of patients taking aripiprazole with a cohort of patients using another AA for depression demonstrated that aripiprazole was independently associated with better (both statistically and clinically) HRQoL and health utilities.

Economic impact of prior authorization policies for atypical antipsychotics in the treatment of schizophrenia.

Prior authorization (PA) policies are increasingly being used to manage atypical antipsychotic (AA) Medicaid drug expenditures; however, some studies suggest that PAs may actually lead to higher rates of treatment discontinuation and hospitalization. A decision analytic model was developed to compare the cost of schizophrenia treatment from a Medicaid perspective when a PA policy for AA is in place with the cost of no PA, over a 1-year time horizon. Deterministic sensitivity analyses were conducted to assess the robustness of the model results when the parameters were varied. A second analysis was performed to assess the incremental impact of PA on hospitalization. The base case model calculates the mean yearly total medical cost for a patient with schizophrenia to be $12,967 (SD $798) under the PA arm and $12,996 (SD $925) with no PA. Results of the probabilistic sensitivity analysis suggest that PA is likely to produce modest cost savings 56% of the time. Analysis of the incremental impact of hospitalization on treatment cost showed that just a 0.5% increase in hospitalization rate in the PA arm will make the PA arm more costly. This analysis suggests that PA is likely to produce only modest cost savings approximately half the time. Sensitivity analyses show that small increases in hospitalizations will make PA the more costly option. Rigorous analysis of the PA policy for AAs is required to ensure that attempts to reduce pharmacy spending do not increase the risk for negative medical outcomes that would offset benefits.

Cognitive development in schizophrenia: follow-back from the first episode.

Despite consensus that schizophrenia is a neurodevelopmental disorder characterized by cognitive deficits, objective data documenting the course of cognitive development remain sparse. We conducted a follow-back study of patients ascertained at the time of their initial episode of schizophrenia or schizoaffective disorder, and a group of demographically matched healthy volunteers. We obtained school records containing standardized achievement test scores from the 1st through 12th grades, and scholastic aptitude test results from the 11th and 12th grades, and examined the developmental trajectories of cognitive performance with respect to prospective examinations conducted following participants' enrollment in our study. We found significant differences in academic achievement tests as early as the first grade, with scores from participants who would later develop schizophrenia lagging behind their peers by 0.8 to 1.1 grade equivalents. This gap widened resulting in a difference between groups of 1.5 to 1.8 grade equivalents by the 12th grade. In the subset of patients for whom SAT scores were available, we found that WAIS-R Full Scale IQ was 11.5 points lower than predicted from earlier SAT scores, suggesting a substantial decline in cognitive ability accompanying the initial episode of illness. These findings suggest that schizophrenia is marked by substantial cognitive deficits in the first grade, that there may be additional subtle decline preceding the overt onset of psychotic symptoms, and that the initial episode of illness is marked by additional decline. These observations may help advance concepts of premorbid cognitive ability in the schizophrenia syndrome and constrain models of pathophysiology.