Costs and Resource Utilization Among Medicaid Patients with Schizophrenia Treated with Paliperidone Palmitate or Oral Atypical Antipsychotics.

BACKGROUND: Non-adherence to antipsychotic therapy among patients with schizophrenia is a key driver of relapse, which can lead to costly inpatient stays. Long-acting injectables (LAIs) may improve adherence, thus reducing hospitalizations, but inpatient cost reductions need to be balanced against higher drug acquisition costs of LAIs. Real-world evidence is needed to help quantify the economic value of oral atypical antipsychotics compared with LAIs. OBJECTIVE: The objective of this study was to compare healthcare costs and resource utilization between once-monthly paliperidone palmitate (PP) and oral antipsychotic therapy (OAT) in a population of Medicaid beneficiaries with schizophrenia. METHODS: A retrospective, observational study was performed using Truven Health MarketScan Medicaid claims data from 2009 to 2012. Marginal structural modeling, a form of weighted repeated measures analysis to control for differences between cohorts and time-varying confounding, was used to estimate monthly costs of care in 2012 US dollars and resource utilization over a 12-month period for patients in each cohort. RESULTS: While per-month mental-health prescription costs were US$1019 higher in the PP cohort, approximately 55 % of this premium was offset by lower inpatient and outpatient care costs, producing a mean monthly total cost differential of US$434 (95 % CI 298-569, p < 0.0001) for all-cause costs and US$463 (95 % CI 374-552, p < 0.0001) for mental-health-related costs. Use of PP also resulted in a 0.44 and 0.47 reduction in the odds of all-cause and mental-health-related hospitalizations and a 0.09 reduction in the odds of all-cause emergency department visits (p < 0.0001, p < 0.0001, and p = 0.0134, respectively) over the 12-month follow-up period. CONCLUSIONS: Treatment with long-acting injectable antipsychotics, such as PP, may reduce inpatient and outpatient healthcare services utilization and associated costs. These findings also suggest that patients with schizophrenia taking once-monthly PP may stand a lower risk of hospitalization than patients on OAT.

Quality of life in pediatric bipolar disorder.

OBJECTIVE: Bipolar disorder is a common mood disorder associated with significant disability and impairment in quality of life in adults. Little research has examined the impact of the disorder on quality of life in children and adolescents. The current study examines the quality of life in children and adolescents with bipolar disorder compared with other physical and psychiatric illnesses. METHODS: This study included 529 youth and caregiver pairs who sought services at a community mental health center or an academic medical center. Diagnoses were based on semistructured interviews of caregivers and youths, and quality of life was determined by the parent-reported Revised Children Quality of Life Questioinnaire (KINDL) questionnaire and compared with published benchmarks for many medical illnesses. RESULTS: Mean age of the youths was 12.0 years, 57% were boys, 72% were black, 22% were white, and 17% had received bipolar disorder diagnoses. Youths with bipolar disorder had significantly lower quality-of-life scores than youths with asthma, atopic dermatitis, obesity, arthritis, oxygen dependence, heart surgery during infancy, depression, behavior disorders, and nonmood and nonbehavior psychiatric diagnoses. CONCLUSIONS: Youths with bipolar disorder reported lower quality of life than other youths encountered in pediatric practice. Pediatricians should attend not only to the child's mood symptoms but also to the overall impairment of the disorder.

A Parent General Behavior Inventory subscale to measure sleep disturbance in pediatric bipolar disorder.

OBJECTIVE: Sleep disturbance is a reliable marker for differentiating children with bipolar spectrum disorders from those with attention-deficit/hyperactivity disorder. Sleep-related items were extracted from the Parent General Behavior Inventory (P-GBI) to determine whether these items, as a scale unto themselves, demonstrate adequate psychometrics to be useful as a possible endophenotypic marker for bipolar spectrum disorders. METHOD: From July 2003 to July 2007, 625 youths and their parents completed semistructured Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version interviews. Parents also completed the 73-item P-GBI. RESULTS: Participants with bipolar spectrum disorders (DSM-IV criteria) scored significantly higher than all other participants on all 7 of the sleep variables (p < .005). On receiver operating characteristic (ROC) analysis, the sleep subscale did substantially as well at discriminating participants with bipolar spectrum disorders as did either of the 2 built-in GBI scales, depression and hypomanic/biphasic (area under the ROC curve = 0.74 vs. 0.75 and 0.77, respectively). CONCLUSION: The P-GBI sleep subscale, developed in this study, is a reliable measure of a wide range of mood-related sleep problems in youths diagnosed with bipolar spectrum disorders. Sleep disturbance appears to be a promising endophenotype for further clinical investigation, and the P-GBI sleep scale may provide an inexpensive way of quantifying this trait for research. Further research needs to evaluate how parent report compares to objective measures of sleep efficiency, such as actigraphy or polysomnography.