Research On Antipsychotics Prescription Patterns Of Patients With Schizophrenia And Associated Health Service Utilization And Direct Medical Cost

Objectives: 1)To describe the drug prescription patterns in patients with schizophrenia.The drugs of interest include typical antipsychotics,atypical antipsychotics,other psychotropic drugs and Traditional Chinese Medicines.2)To assess the adherence,persistence and treatment changes for patients initiated with different antipsychotic therapies of interest.3)To describe the health care services utilization and cost associated with typical and atypical antipsychotics.Methods: Data were 30% random sampling from the Tianjin Urban Employee Basic Medical Insurance(UEBMI)database.Adult patients with ? 1 diagnosis of schizophrenia,antipsychotics prescribed at the first diagnosis of schizophrenia(index date),and 12-month continuous enrollment after the first antipsychotic prescription(follow-up period)between 2008 and 2010 were included.Patients with newly initiating or restarting antipsychotics were defined as patients with no antipsychotics during previous 90 days.Patients' characteristics,classes and number of antipsychotics patients prescribed,medication adherence,patterns of antipsychotics patients maintained / changed and direct medical cost were described and the differences were compared between subsamples using t-test and one way ANOVA for continuous characteristics and chi-squared test for categorical characteristics.Results: 1)A total of 2125 schizophrenia patients were identified with a mean age of 52.3 years.During the following 12 months,92.0% patients were prescribed with antipsychotics,7.1% patients with concomitant psychotropics alone,and 0.9% patients without any psychotropics prescribed.2)1739 patients were prescribed with antipsychotics at index date,84.0% with one antipsychotic.During the following 12 months,34.5% of the patients were prescribed with typical antipsychotics,40.4% with atypical antipsychotics and 25.1% with both.3)The adherence of 1739 patients is 0.39(±0.32)during the following 12 months,and the adherence for typical antipsychotics is higher than atypical(0.42(±0.34)vs.0.34(±0.30),p=0.001).During the following 12 months,83.7% of the patients were with a discontinuation of more than 30 days,and 79.8% remained on the index antipsychotic class.4)During the following 12 months among the 2125 patients,59.8% of the patients had at least one record of hospitalization,and the proportion of hospitalization was significantly lower for patients prescribed with atypical antipsychotics compared with ones with typicals(46.4% vs.70.3%,p<0.001).5)The total direct medical cost was 11,966.5(±14422.2)CNY,and there was no significant differences between typical and atypical antipsychotics for patients with newly initiating or restarting antipsychotics(p=0.524).Conclusions: Antipsychotics were the major medications prescribed among the psychotropic drug therapy,and typical and atypical antipsychotics were both widely prescribed as the first line drugs.The majority of patients were prescribed with monotherapy,and tended to stay with one antipsychotic medication class.However,the medication adherence was low.The proportion of hospitalization for patients with atypical antipsychotic medications was lower than typicals,and there was no significant difference for the total medical cost,and the reasons should be assessed and explored further.