SAN ANTONIO, TX—In “real-world” settings, patients with bipolar disorder who received lurasidone monotherapy had “significantly lower odds of mental health-related hospitalizations” when compared with olanzapine, quetiapine, and risperidone monotherapy, results of a retrospective analysis presented at the U.S. Psychiatric & Mental Health Congress has found.
“With inpatient healthcare utilization costs making up a large amount of healthcare expenditures in patients with bipolar disorder, reducing hospitalizations through effective medication treatments may lead to cost savings,” noted John Beyer, MD, Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC.
To assess the rates of mental health-related hospitalization among patients with bipolar disorder treated with lurasidone vs. other atypical antipsychotic monotherapy, Dr. Beyer and colleagues used the Optum Research Database to analyze U.S. commercial claims data from April 1, 2010, to September 30, 2014.
Index date was defined as the first atypical antipsychotic claim; the pre-index period was 180 days and the post-index period, 360 days.
Noting that “in usual clinical care, patients with bipolar disorder often stop, switch, or augment therapy,” they controlled for these effects by dividing the 360-day follow-up into 12 months, or 30-day intervals. Monotherapy was defined as 22 or more days of treatment during this interval “with no coverage of another atypical antipsychotic or lithium or valproate.”
During the study period, 11,132 patients met the inclusion criteria. Initial monotherapy treatments were aripiprazole (n=2,818), lurasidone (n=148), olanzapine (n=555), quetiapine (n=2,233), risperidone (n=1,094), and ziprasidone (n=496); in addition, 97 patients received minimal and 3,691, other treatment.
The majority of the patients was female, 63.6%, and average age was 38.6 years.
“The most common type of bipolar diagnosis was unspecific (44.2%), followed by depression (31.3%), mixed (13.8%), and mania (10.7%),” Dr. Beyer noted. Common baseline comorbidities were hyperlipidemia (17.7%), obesity (6.8%), and type 2 diabetes (6.9%).
“Prior to adjusting for baseline characteristics, monotherapy treatment with lurasidone was associated with a significantly lower rate of mental health-related admissions as compared with olanzapine and quetiapine,” the investigators found.
After controlling for treatment in the prior month, baseline differences, and time-varying covariates, a multivariate analysis “found that all cohorts had more than double the odds of a mental health-related inpatient stay than the lurasidone cohort in the 12-month follow-up period.”
The study authors concluded that “further study is needed to evaluate the potential cost savings of effective atypical antipsychotics in bipolar disorder.”