Background
Methods
Data source
Study sample
Measures
Statistical analysis
Sensitivity analysis
Results
Baseline characteristics
Variable | Before matching | After matching | ||||||
---|---|---|---|---|---|---|---|---|
Atypical cohort N = 648 | Typical cohort N = 483 | p-value | Standardized difference | Atypical cohort N = 400 | Typical cohort N = 400 | p-value | Standardized difference | |
Demographic characteristics
| ||||||||
Mean age (in years) [Mean(SD)] | 51.3 (13.0) | 52.6 (11.9) | 0.081 |
−0.106
| 52.1 (11.8) | 51.7 (11.7) | 0.144 | 0.035 |
Female [n(%)] | 357 (55.1%) | 267 (55.3%) | 0.950 | −0.004 | 226 (56.5%) | 224 (56.0%) | 0.715 | 0.010 |
Retired [n(%)] | 338 (52.2%) | 282 (58.4%) |
0.037
|
−0.125
| 222 (55.5%) | 228 (57.0%) | 0.109 | −0.030 |
Concomitant medications [n(%)]
| ||||||||
Anxiolytics | 74 (11.4%) | 57 (11.8%) | 0.843 | −0.012 | 18 (4.5%) | 22 (5.5%) | 0.541 | −0.046 |
Anticholinergics | 28 (4.3%) | 15 (3.1%) | 0.290 | 0.064 | 1 (0.3%) | 1 (0.3%) | 1.000 | <0.001 |
Antidepressants | 24 (3.7%) | 22 (4.6%) | 0.473 | −0.043 | 1 (0.3%) | 4 (1.0%) | 0.375 | −0.095 |
Sedative-hypnotics | 9 (1.4%) | 17 (3.5%) |
0.018
|
−0.138
| 1 (0.3%) | 3 (0.8%) | 0.625 | −0.071 |
Mood stabilizers | 7 (1.1%) | 6 (1.2%) | 0.787 | −0.015 | 2 (0.5%) | 1 (0.3%) | 1.000 | 0.041 |
Mental comorbidities [n(%)]
| ||||||||
Sleep disorder | 38 (5.9%) | 29 (6.0%) | 0.921 | −0.006 | 14 (3.5%) | 10 (2.5%) | 0.481 | 0.059 |
Depression | 15 (2.3%) | 16 (3.3%) | 0.309 | −0.060 | 1 (0.3%) | 4 (1.0%) | 0.375 | −0.095 |
Anxiety disorder | 8 (1.2%) | 9 (1.9%) | 0.462 | −0.051 | 3 (0.8%) | 2 (0.5%) | 1.000 | 0.032 |
Other psychotic disorder# | 6 (0.9%) | 3 (0.6%) | 0.740 | 0.035 | 1 (0.3%) | 0 (0.0%) | 1.000 | 0.071 |
Resource utilization and cost (prior 3 months)
| ||||||||
Mean number of hospitalizations | 0.02 (0.15) | 0.05 (0.25) |
0.028
|
−0.128
| 0.01 (0.07) | 0.01 (0.07) | 1.000 | <0.001 |
Mean number of outpatient visits | 0.17 (0.58) | 0.22 (0.83) | 0.332 | −0.069 | 0.08 (0.34) | 0.05 (0.36) | 0.298 | 0.071 |
Direct medical cost ($) [Mean(SD)] | 20 (124) | 42 (200) |
0.027
|
−0.129
| 4 (45) | 3 (46) | 0.287 | 0.021 |
Descriptive analyses of health care resource utilization
Variable | Before matching | After matching | ||||
---|---|---|---|---|---|---|
Atypical cohort N = 648 | Typical cohortN = 483 | p-value | Atypical cohort N = 400 | Typical cohort N = 400 | p-value | |
Pharmacy resource utilization
| ||||||
Use of antipsychotics [mean(SD)]
| ||||||
Days on of all antipsychotics | 139.1 (109.0) | 143.7 (109.2) | 0.483 | 143.2 (110.7) | 143.9 (108.0) | 0.938 |
Time to all-cause discontinuation | 111.0 (117.8) | 110.2 (114.0) | 0.910 | 113.2 (117.0) | 109.0 (111.8) | 0.606 |
Use of concomitant medication [n(%)]
| ||||||
Any use of anxiolytics | 476 (73.5%) | 412 (85.3%) |
<0.001
| 275 (68.8%) | 342 (85.5%) |
<0.001
|
Any use of anticholinergics | 216 (33.3%) | 316 (65.4%) |
<0.001
| 143 (35.8%) | 265 (66.3%) |
<0.001
|
Any use of antidepressants | 147 (22.7%) | 78 (16.2%) |
0.006
| 80 (20.0%) | 57 (14.3%) |
0.028
|
Any use of sedative-hypnotics | 256 (39.5%) | 122 (25.3%) |
<0.001
| 163 (40.8%) | 100 (25.0%) |
<0.001
|
Any use of mood stabilizers | 78 (12.0%) | 52 (10.8%) | 0.507 | 47 (11.8%) | 42 (10.5%) | 0.569 |
Medical resource utilization
#
| ||||||
Any psychiatric hospitalization [n(%)] | 297 (45.8%) | 274 (56.7%) |
<0.001
| 192 (48.0%) | 231 (57.8%) |
0.002
|
The number of psychiatric hospitalizations [mean(SD)] | 1.65 (0.76) | 1.72 (0.81) | 0.291 | 1.65 (0.76) | 1.71 (0.83) | 0.487 |
Length of stay per hospitalization [mean(SD)] | 85.6 (84.7) | 94.8 (84.2) | 0.094 | 88.3 (86.9) | 92.9 (82.9) | 0.473 |
Any psychiatric outpatient visit [n(%)] | 519 (80.1%) | 318 (65.8%) |
<0.001
| 310 (77.5%) | 261 (65.3%) |
<0.001
|
The number of psychiatric outpatient visits [mean(SD)] | 7.95 (7.26) | 6.96 (6.25) |
0.044
| 7.71 (6.89) | 6.52 (5.70) |
0.027
|
Mental comorbidities
| ||||||
Mean number of mental comorbidities [mean(SD)]
| 0.72 (0.92) | 0.54 (0.84) |
<0.001
| 0.64 (0.87) | 0.49 (0.80) |
0.012
|
Specific mental comorbidities
##
[n(%)]
| ||||||
Sleep disorder | 131 (20.2%) | 84 (17.4%) | 0.231 | 70 (17.5%) | 63 (15.8%) | 0.514 |
Unspecified mental disorder | 112 (17.3%) | 75 (15.5%) | 0.432 | 63 (15.8%) | 59 (14.8%) | 0.700 |
Depression | 110 (17.0%) | 52 (10.8%) |
0.003
| 57 (14.3%) | 39 (9.8%) | 0.052 |
Anxiety disorder | 77 (11.9%) | 37 (7.7%) |
0.020
| 42 (10.5%) | 27 (6.8%) | 0.063 |
Other psychotic disorder | 35 (5.4%) | 13 (2.7%) |
0.025
| 23 (5.8%) | 7 (1.8%) |
0.004
|
Descriptive analyses of direct medical costs
Variable | Before matching | After matching | ||||||
---|---|---|---|---|---|---|---|---|
Atypical cohort N = 648 | Typical cohort N = 483 | Diff | p-value | Atypical cohort N = 400 | Typical cohort N = 400 | Diff | p-value | |
Total costs
| 1661 (2224) | 1892 (2465) | −231 | 0.100 | 1711 (2240) | 1868 (2450) | −157 | 0.341 |
Medication costs
| 438 (626) | 187 (337) | 251 |
<0.001
| 409 (526) | 172 (334) | 237 |
<0.001
|
Antipsychotic medication | 288 (431) | 63 (216) | 225 |
<0.001
| 268 (343) | 64 (230) | 204 |
<0.001
|
Concomitant medication | 73 (266) | 42 (98) | 31 |
0.014
| 61 (194) | 40 (99) | 20 | 0.064 |
Other medication# | 77 (197) | 82 (213) | −5 | 0.680 | 81 (207) | 68 (189) | 13 | 0.344 |
Medical costs
| 1223 (2058) | 1704 (2344) | −482 |
<0.001
| 1302 (2097) | 1696 (2325) | −394 |
0.011
|
Costs of inpatient services
##
| 1213 (2061) | 1699 (2346) | −486 |
<0.001
| 1292 (2099) | 1692 (2327) | −399 |
0.010
|
Non-medication treatment costs | 667 (1186) | 992 (1443) | −325 |
<0.001
| 716 (1223) | 977 (1422) | −262 |
0.005
|
Laboratory and diagnostic cost | 254 (456) | 388 (548) | −134 |
<0.001
| 278 (477) | 393 (546) | −115 |
0.001
|
Other inpatient services | 292 (539) | 319 (476) | −27 | 0.384 | 299 (516) | 321 (482) | −22 | 0.528 |
Costs of outpatient services
| 10 (28) | 5 (26) | 5 |
0.004
| 9 (25) | 4 (11) | 5 |
<0.001
|
Multivariate analyses
Variable | Before matching N = 1131 | After matching N = 800 | ||||
---|---|---|---|---|---|---|
OR | 95% CI | p-value | OR | 95% CI | p-value | |
Medical service
| ||||||
Any psychiatric hospitalization |
0.58
| 0.44-0.75 |
<0.001
|
0.66
| 0.49-0.89 |
0.006
|
Any psychiatric clinical visit |
2.19
| 1.64-2.93 |
<0.001
|
1.81
| 1.32-2.50 |
<0.001
|
Use of concomitant medication
| ||||||
Any use of anxiolytics |
0.43
| 0.31-0.60 |
<0.001
|
0.37
| 0.26-0.53 |
<0.001
|
Any use of anticholinergics |
0.24
| 0.18-0.31 |
<0.001
|
0.26
| 0.19-0.35 |
<0.001
|
Any use of antidepressants |
1.64
| 1.18-2.28 |
0.003
|
1.49
| 1.01-2.20 |
0.044
|
Any use of sedative-hypnotics |
1.89
| 1.45-2.46 |
<0.001
|
2.11
| 1.55-2.88 |
<0.001
|
Any use of mood stabilizers | 1.11 | 0.75-1.64 | 0.605 | 1.09 | 0.69-1.72 | 0.706 |
Variable | Before matching N = 1131 | After matching N = 800 | ||||||
---|---|---|---|---|---|---|---|---|
OLS | GLM | OLS | GLM | |||||
Diff | p-value | Diff | p-value | Diff | p-value | Diff | p-value | |
Total costs
| −229 | 0.091 |
−238
|
0.031
| −161 | 0.329 | −150 | 0.245 |
Medication costs
|
247
|
<0.001
|
242
|
<0.001
|
238
|
<0.001
|
234
|
<0.001
|
Antipsychotic medication |
217
|
<0.001
|
235
|
<0.001
|
204
|
<0.001
|
229
|
<0.001
|
Concomitant medication |
30
|
0.016
|
22
|
<0.001
| 21 | 0.052 |
16
|
<0.001
|
Other medication# | 1 | 0.959 | 7 | 0.190 | 12 | 0.392 |
15
|
0.005
|
Medical costs
|
−476
|
<0.001
|
−569
|
<0.001
|
−399
|
0.011
|
−450
|
<0.001
|
Costs of inpatient services
##
|
−481
|
<0.001
|
−592
|
<0.001
|
−404
|
0.010
|
−555
|
<0.001
|
Non-medication treatment cost |
−315
|
<0.001
|
−401
|
<0.001
|
−269
|
0.004
|
−351
|
<0.001
|
Laboratory and diagnostic cost |
−136
|
<0.001
|
−158
|
<0.001
|
−113
|
0.002
|
−131
|
<0.001
|
Other inpatient services | −30 | 0.324 | −39 | 0.056 | −22 | 0.532 | −29 | 0.229 |
Costs of outpatient services
|
5
|
0.002
|
6
|
<0.001
|
5
|
<0.001
|
5
|
<0.001
|