Introduction
Methods
Data Source
Sample Selection and Patient Population
Patient Demographics and Clinical Characteristics
Outcome Measures
Statistical Analysis
Results
Patient Population
Variable | Unmatched population | Absolute standardized differences | ||
---|---|---|---|---|
EPS | Non EPS |
P value | ||
Patients (n) | 583 | 4,038 | ||
Age, mean (SD) | 36.5 (12.3) | 38.9 (11.9) |
<0.001
|
0.002
|
Sex (n) (%) |
<0.001
| |||
Male | 336 (57.6) | 1,972 (48.8) | 0.177 | |
Female | 247 (42.4) | 2,066 (51.2) | 0.177 | |
Non fee for service health plans (n) (%) | 227 (38.9) | 1,523 (37.7) | 0.570 |
0.025
|
Race (n) (%) |
0.036
| |||
White | 178 (30.5) | 1,453 (36.0) | 0.116 | |
African American | 337 (57.8) | 2,216 (54.9) | 0.059 | |
Hispanic | 9 (1.5) | 47 (1.2) |
0.033
| |
Other | 59 (10.1) | 322 (8.0) | 0.075 | |
Year of the first AAP fill (n) (%) | 0.540 | |||
2004 | 135 (23.2) | 956 (23.7) | 0.012 | |
2005 | 161 (27.6) | 1,230 (30.5) | 0.063 | |
2006 | 102 (17.5) | 690 (17.1) |
0.011
| |
2007 | 81 (13.9) | 523 (13.0) |
0.028
| |
2008 | 104 (17.8) | 639 (15.8) |
0.054
| |
Index treatment (n) (%) |
<0.001
| |||
Aripiprazole | 40 (6.9) | 496 (12.3) | 0.185 | |
Clozapine | 7 (1.2) | 42 (1.0) |
0.015
| |
Olanzapine | 32 (5.5) | 580 (14.4) | 0.300 | |
Paliperidone | 11 (1.9) | 73 (1.8) | 0.006 | |
Quetiapine | 52 (8.9) | 954 (23.6) | 0.407 | |
Risperidone | 358 (61.4) | 1,430 (35.4) | 0.539 | |
Ziprasidone | 83 (14.2) | 463 (11.5) | 0.083 | |
Resource utilization | ||||
Medication burden, mean (SD) | 2.6 (4.0) | 3.8 (4.9) |
<0.001
|
0.003
|
All-cause hospitalizations (≥1) (n) (%) | 238 (40.8) | 1,392 (34.5) |
0.003
| 0.131 |
All-cause ER visits (≥1), (n) (%) | 357 (61.2) | 2,287 (56.6) |
0.036
| 0.094 |
All-cause office visits (≥1), (n) (%) | 269 (46.1) | 2,123 (52.6) |
0.004
| 0.129 |
CCI, mean (SD) | 0.4 (1.1) | 0.5 (1.2) |
0.033
|
0.001
|
Comorbidities (n) (%) | ||||
Anxiety disorders | 57 (9.8) | 451 (11.2) | 0.315 |
0.046
|
Major depression | 92 (15.8) | 636 (15.8) | 0.985 |
0.001
|
Bipolar disorder | 24 (4.1) | 134 (3.3) | 0.322 |
0.042
|
Personality disorders | 24 (4.1) | 157 (3.9) | 0.790 |
0.012
|
Substance use disorders | 149 (25.6) | 979 (24.2) | 0.490 |
0.030
|
Hypertension | 95 (16.3) | 802 (19.9) |
0.042
| 0.093 |
Metabolic syndrome | 65 (11.1) | 684 (16.9) |
<0.001
| 0.167 |
Healthcare Utilization and Costs
Variable | EPS | Non EPS | Odds ratio (95 % CI) |
P value |
---|---|---|---|---|
Patients (n) | 583 | 4,038 | ||
Resource utilization (n) (%) | ||||
All-cause hospitalizations (≥1) | 213 (36.5) | 1,102 (27.3) |
1.53 (1.28, 1.84)
|
<0.001
|
All-cause ER visits (≥1) | 367 (63.0) | 2,520 (62.4) | 1.02 (0.86, 1.23) | 0.800 |
All-cause office visits (≥1) | 393 (67.4) | 2,854 (70.7) | 0.86 (0.71, 1.03) | 0.107 |
Schizophrenia-specific hospitalizations (≥1) | 121 (20.8) | 437 (10.8) |
2.16 (1.73, 2.70)
|
<0.001
|
Schizophrenia-specific ER visits (≥1) | 169 (29.0) | 789 (19.5) |
1.68 (1.38, 2.04)
|
<0.001
|
Schizophrenia-specific office visits (≥1) | 81 (13.9) | 500 (12.4) | 1.14 (0.89, 1.47) | 0.304 |
Cost difference (95 % CI) | ||||
---|---|---|---|---|
Healthcare costs, mean (SD)a
| ||||
All-cause ER costs | $1,060 (2,481) | $947 (2,336) | $112 (−$92, $317) | 0.303 |
All-cause inpatient costs | $7,196 (17,608) | $6,012 (25,165) | $1,184 (−$931, $3,298) | 0.154 |
All-cause outpatient costs | $5,734 (9,803) | $6,027 (11,481) | −$293 (−$1,273, $687) | 0.510 |
All-cause prescription drug costs | $4,693 (4,818) | $4,228 (5,929) |
$465 ($33, $897)
|
0.035
|
All-cause total healthcare costs | $18,682 (24,337) | $17,214 (30,891) | $1,468 (−$1,150, $4,086) | 0.190 |
Schizophrenia-specific ER costs | $232 (604) | $130 (482) |
$102 ($58, $145)
|
<0.001
|
Schizophrenia-specific inpatient costs | $3,146 (9,978) | $1,366 (6,294) |
$1,780 ($1,184, $2,377)
|
<0.001
|
Schizophrenia-specific outpatient costs | $2,494 (5,656) | $1,987 (5,558) |
$507 ($23, $991)
|
0.040
|
Schizophrenia-specific prescription drug costs | $3,505 (3,580) | $2,765 (2,916) |
$739 ($478, $1,001)
|
<0.001
|
Atypical antipsychotics | $3,202 (3,345) | $2,425 (2,699) |
$777 ($535, $1,019)
|
<0.001
|
Antidepressants | $228 (488) | $264 (527) | −$36 (−$81, $9) | 0.100 |
Anxiety medications | $94 (330) | $106 (362) | −$13 (−$44, $19) | 0.397 |
Mood stabilizers | $57 (325) | $51 (344) | $5 (−$24, $35) | 0.718 |
Schizophrenia-specific total healthcare costs | $9,377 (13,358) | $6,249 (9,587) |
$3,128 ($2,248, $4,009)
|
<0.001
|
Multivariate Analysis
Variable | EPS | Non EPS | Odds ratio (95 % CI)a
|
P value |
---|---|---|---|---|
Patients (n) | 583 | 583 | ||
Resource utilization (n) (%)a
| ||||
All-cause hospitalizations (≥1) | 213 (36.5) | 176 (30.2) |
1.33 (1.04, 1.70)
|
0.022
|
All-cause ER visits (≥1) | 367 (63.0) | 384 (65.9) | 0.88 (0.69, 1.12) | 0.298 |
All-cause office visits (≥1) | 393 (67.4) | 363 (62.3) | 1.25 (0.99, 1.60) | 0.066 |
Schizophrenia-specific hospitalizations (≥1) | 121 (20.8) | 84 (14.4) |
1.56 (1.15, 2.11)
|
0.004
|
Schizophrenia-specific ER visits (≥1) | 169 (29.0) | 139 (23.8) |
1.30 (1.00, 1.69)
|
0.046
|
Schizophrenia-specific office visits (≥1) | 81 (13.9) | 75 (12.9) | 1.09 (0.78, 1.53) | 0.606 |
Cost difference (95 % CI)b
| ||||
---|---|---|---|---|
Healthcare costs, mean (SD)b
| ||||
All-cause ER costs | $1,060 (111) | $912 (104) | $148 (−$78, $455) | |
All-cause inpatient costs | $7,196 (756) | $5,055 (517) |
$2,140 ($508, $4,019)
| |
All-cause outpatient costs | $5,734 (412) | $5,435 (433) | $299 (−$965, $1,359) | |
All-cause prescription drug costs | $4,693 (198) | $3,728 (170) |
$965 ($511, $1,516)
| |
All-cause total healthcare costs | $18,682 (930) | $15,130 (810) |
$3,552 ($683, $5,830)
| |
Schizophrenia-specific ER costs | $232 (25) | $128 (16) |
$103 ($50, $163)
| |
Schizophrenia-specific inpatient costs | $3,146 (411) | $1,840 (282) |
$1,307 ($477, $2,346)
| |
Schizophrenia-specific outpatient costs | $2,494 (266) | $2,100 (221) | $395 (−$214, $1,094) | |
Schizophrenia-specific prescription drug costs | $3,505 (143) | $2,621 (123) |
$884 ($504, $1,283)
| |
Atypical antipsychotics | $3,202 (136) | $2,348 (115) |
$855 ($521, $1,220)
| |
Antidepressants | $228 (21) | $209 (19) | $20 (−$34, $72) | |
Anxiety medications | $94 (14) | $82 (15) | $12 (−$28, $45) | |
Mood stabilizers | $57 (13) | $51 (13) | $6 (−$28, $42) | |
Schizophrenia-specific total healthcare costs | $9,377 (517) | $6,688 (441) |
$2,689 ($1,518, $4,190)
|