Drug Prescription Patterns in Schizophrenia Outpatients: Analysis of Data from a German Health Insurance Fund

 

 Buy Article Permissions and Reprints

Abstract

Introduction: The aim of this study was to investigate routine administrative data from a major German health insurance fund, Techniker Krankenkasse, which covers 5.4 million insured individuals. Using a retrospective cohort design, this study analysed data collected from patients with a hospital diagnosis of schizophrenia in 2003 (index hospitalisation) in order to evaluate prescription patterns of antipsychotic drugs.

Methods: Patients with an ICD-10 diagnosis of schizophrenia, at least one year prior membership with the insurance fund and a follow-up period of one year were identified. Results were standardised by age and stratified by the severity of their illness, defined by the number of hospital bed days during the three years preceding the index hospitalisation.

Results: A total of 3 121 patients with schizophrenia (male 56.4%, female 43.6%) received 56 692 single prescriptions of antipsychotics. Of these, 35.4% of the prescriptions were for typical and 64.6% for atypical antipsychotics; 55% were for high-potency, 45% for low-potency typical antipsychotics. The most frequently prescribed drugs were olanzapine (26.6%), clozapine (21.3%) and risperidone (19%). There were no relevant gender differences concerning prescription patterns. During a 12-month follow-up period after the first hospitalisation, 1 372 patients (43.9%) were treated exclusively with an atypical antipsychotic, another 499 patients (16%) had a combination of an atypical plus a low-potency typical antipsychotic. Thus, basal therapy with an atypical was observed in 59.9% of our study population. Only 327 patients (10.5%) were treated exclusively with a typical antipsychotic. A total of 645 patients (20.7%) were treated with a combination of atypical plus typical antipsychotic. Changes of medication within one substance group occurred more often with typical antipsychotics (50%) as compared to atypical antipsychotics (25%).

Discussion: At 60%, the proportion of patients in this study treated with atypical antipsychotics was surprisingly high. Of significant interest is the frequent prescription of clozapine (14%). The results are discussed in comparison to comparable studies from other countries.

References

• 1 American Psychiatric Association . Practice guideline for treatment of patients with schizophrenia.  Am J Psychiatry. 2001;  154 1-63
  PubMedGoogle Scholar
• 2 Atik L, Erdogan A, Karaahmet E. et al . Antipsychotic prescriptions in a university hospital outpatient population in Turkey: A retrospective database analysis, 2005–2006.  Prog Neuropsychopharmacol Biol Psychiatry. 2008;  , Epub ahead of print
  PubMedGoogle Scholar
• 3 Ballerini A, Boccalon RM, Boncompagnie G. et al . Clinical features and therapeutic management of patients admitted to Italian acute hospital psychiatric units, the PERSEO (psychiatric emergency study and epidemiology) survey.  Ann Gen Psychiatry. 2007;  6 29
  CrossrefPubMedGoogle Scholar
• 4 Bagnall AM, Jones L, Ginnelly L. et al . A systematic review of atypical antipsychotic drugs in schizophrenia.  Health Technol Assess. 2003;  7 1-193
  PubMedGoogle Scholar
• 5 Bromet EJ, Fennig S. Epidemiology and natural history of schizophrenia.  Biol Psychiatry. 1999;  46 871-881
  CrossrefPubMedGoogle Scholar
• 6 Clade H. Fallbeispiel Schizophrenie: Hohe soziale Kosten.  Dt Ärzteblatt. 2003;  100A 1924-1925
  PubMedGoogle Scholar
• 7 Csernansky JG, Mahmoud R, Brenner R. A comparison of risperidone and haloperidol for the prevention of relapse in patients with schizophrenia.  N Engl J Med. 2002;  346 16-22
  CrossrefPubMedGoogle Scholar
• 8 Davis JM, Chen N, Glick ID. A meta-analysis of the efficacy of second-generation antipsychotics.  Arch Gen Psychiatry. 2003;  60 553-560
  CrossrefPubMedGoogle Scholar
• 9 Dossenbach M, Arango-Davila C, Ibarra HS. et al . Response and relapse in patients with schizophrenia treated with olanzapine, risperidone, quetiapine, or haloperidole: 12-month follow-up of the Intercontinental Schizophrenia Outpatient Health Outcomes (IC-SOHO) Study.  J Clin Psychiatry. 2005;  66 1021-1030
  CrossrefPubMedGoogle Scholar
• 10 Essock SM, Hargreaves WA, Covell NH. et al . Clozapine's effectiveness for patients in state hospitals: results from a randomized trial.  Psychopharmacol Bull. 1996;  32 683-697
  PubMedGoogle Scholar
• 11 Hamann J, Pfeifer H, Kissling W. Are patients with schizophrenia under-treated with second-generation antipsychotics? A pilot study of the prescription practices of German psychiatrists.  Pharmacopsychiatry. 2003;  36 309-312
  Article in Thieme ConnectPubMedGoogle Scholar
• 12 Haro JM, Edgell ET, Frewer P. et al . The European Schizophrenia Outpatient Health Outcomes (SOHO) Study: baseline findings across country and treatment.  Acta Psychiatr Scand. 2003;  107 ((Suppl. 416)) 7-15
  CrossrefPubMedGoogle Scholar
• 13 Kissling W, Hoffler J, Seemann U. et al . Direct and indirect costs of schizophrenia.  Fortschr Neurol Psychiat. 1999;  67 29-36
  Article in Thieme ConnectPubMedGoogle Scholar
• 14 Knapp M. Costs of schizophrenia.  Br J Psychiatry. 1997;  171 509-518
  CrossrefPubMedGoogle Scholar
• 15 Liebermann JA, Stroup TS, MacEvoy JP. et al . Effectiveness of antipsychotic drugs in patients with chronic schizophrenia.  N Engl J Med. 2005;  353 1209-1223
  CrossrefPubMedGoogle Scholar
• 16 Marder SR, Meibach RC. Risperidone in the treatment of schizophrenia.  Am J Psychiatry. 1994;  151 825-835
  PubMedGoogle Scholar
• 17 Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study.  Lancet. 1997;  349 1498-1504
  CrossrefPubMedGoogle Scholar
• 18 Rosenheck R, Perlick D, Bingham S. et al . Effectiveness and cost of olanzapine and haloperidol in the treatment of schizophrenia: a randomized controlled trial.  JAMA. 2003;  290 2693-2702
  CrossrefPubMedGoogle Scholar
• 19 Rosenheck RA. Effectiveness versus efficacy of second generation antipsychotics: Haloperidol without anticholinergics as a comparator. http://www.ps.psychiatryonline.org , Accessed Oct 11th 2005
  PubMed
• 20 Schwabe U, Paffrath D. eds. Arzneiverordnungsreport 2004. Berlin, Heidelberg: Springer 2004
• 21 Sernyak MJ, Leslie D, Rosenheck R. Use of system-wide outcomes monitoring data to compare the effectiveness of atypical neuroleptic medications.  Am J Psychiatry. 2003;  160 310-315
  CrossrefPubMedGoogle Scholar
• 22 Tang YL, Mao PX, Jiang F. Clozapine in China.  Pharmacopsychiatry. 2008;  41 1-9
  Article in Thieme ConnectPubMedGoogle Scholar
• 23 Tiihonen J, Wahlbeck K, Lönnqvist J. et al . Effectiveness of antipsychotic treatments in a nationwide cohort of patients in community care after first hospitalisation due to schizophrenia and schizoaffective disorder: observational follow-up study.  BMJ. 2006;  333 224
  CrossrefPubMedGoogle Scholar
• 24 Tollefson GD, Beasley JM, Tran PV. Olanzapine versus haloperidol in the treatment of schizophrenia and schizoaffective disorders and schizophreniforme disorders: results of an international collaborative trial.  Am J Psychiatry. 1997;  154 457-465
  PubMedGoogle Scholar
• 25 Weiden PJ, Kozma C, Grogg A. et al . Partial compliance and risk of rehospitalization among California Medicaid patients with schizophrenia.  Psychiatr Serv. 2004;  55 886-891
  CrossrefPubMedGoogle Scholar
• 26 Whiteford H, Teeson M, Scheurer R. et al .Responding to the burden of mental illness. Commission for Macroeconomics and Health: Geneva 2001
• 27 World Health Organization .The World Health Report 2003. WHO: Geneva 2003
• 28 Xiang YT, Weng YZ, Leung CM. Clinical and social determinants of antipsychotic polypharmacy for Chinese patients with schizophrenia.  Pharmacopsychiatry. 2007;  40 47-52
  Article in Thieme ConnectPubMedGoogle Scholar

Correspondence

G. JuckelMD, PhD 

Department of Psychiatry

Ruhr-University Bochum

LWL University Hospital

Alexandrinenstr. 1

44791 Bochum

Germany

Phone: +49/234/5077 201

Fax: +49/234/5077 204

Email: georg.juckel@wkp-lwl.org