Inpharma 1342 - 15 Jun 2002

Antipsychotics clearly beneficial in bipolar disorder– Kimberley Salmon –

Bipolar disorder is a psychiatric condition that is both serious and costly. Indeed, bipolar disorder accounts forapproximately $US7.6 million annually in direct healthcare costs in the US. Atypical antipsychotic drugs areincreasingly being used to treat this disorder, instead of older, less costly conventional antipsychotics. Despitethe higher acquisition costs associated with atypical antipsychotics, evidence suggests that their use may in factlower overall healthcare costs, due to their favourable safety and efficacy profiles, compared with conventionalantipsychotics. At the 7th Annual Meeting of the International Society for Pharmacoeconomics and OutcomesResearch [Arlington, Virginia, US; May 2002], three studies addressed the use of atypical antipsychotics inbipolar disorder, and the resulting impact on healthcare costs, resource use and hospitalisation.

The first of the three studies was conducted by Dr recipients (12.8 vs 20.4 and 21.3 outpatient providerBaojin Zhu and colleagues from the US, and examined visits, respectively). Risperidone was also associatedthe costs associated with the use of two atypical with less frequent use of inpatient services comparedantipsychotics, olanzapine and valproate semisodium with olanzapine over the 6 month period. The mean per-[divalproex sodium; ‘Depakote’] in patients with bipolar patient costs associated with psychiatric healthcare1 disorder.1* As bipolar disorder is considered to be service use for risperidone, olanzapine and quetiapineamong the most costly of psychiatric disorders, with were $US2775, $US6186 and $US4022 per patient,considerable direct and indirect costs associated with respectively.† Overall, mean costs of care associatedtreatment and patient care, Dr Zhu and colleagues noted with all services were lowest for risperidone recipients,the importance of gaining data regarding the compared with olanzapine, and quetiapine, recipients‘comparative value of medication treatment options’. [see table].

Their 47-week study involved 251 patients with Reducing the burden to patients, caregiversbipolar disorder (acute mania or mixed episode) who Psychotic disorders, including bipolar disorder,were randomised to receive either olanzapine 5–20 represent a significant burden not only to patients butmg/day or valproate semisodium 500–2500 mg/day. also to their caregivers, and the role of atypicalPatients were hospitalised at baseline and for at least antipsychotics in reducing that burden was the subjectone week following randomisation. A subgroup of of the third study, conducted by Dr WR Simons ofolanzapine recipients (n = 77) and valproate Global Health Economics & Outcomes Research, Inc.,semisodium recipients (70) completed a 3-week acute US, and colleagues.3‡ They used data from the UStreatment phase and continued into a 44-week Medical Expenditure Panel Survey (MEPS), which hasmaintenance treatment phase. been conducted annually since 1996, to identify aLower inpatient and outpatient costs with cohort of patients who had received a diagnosis ofolanzapine schizophrenia or other psychotic disorder (n = 112);

patients’ family members formed the caregiver cohortThe results showed that there was no significant(213). Other responders to the MEPS questionnaire (n =difference in overall per-patient costs between the two8628) and their family members (13 648) formed thetreatment groups. Olanzapine was associated withcontrol groups. Patients were further evaluatedsignificantly higher acquisition costs than valproateaccording to whether they received atypical, orsemisodium; however, these costs were offset byconventional, antipsychotics. The researchers used twosignificantly lower overall inpatient, partialmodels in their analysis to determine the effects ofhospitalisation and outpatient costs for olanzapine,psychotic disorders on total annual income bycompared with valproate semisodium, over the studyconsideration of variables such as social, physical orperiod. Higher outpatient costs incurred by valproatecognitive limitations, and patients’ difficulty insemisodium recipients were attributed to additionalperforming independent activities of daily living.emergency-room and other outpatient visits, compared

with olanzapine. Considerable direct costsRisperidone lowers resource use, costs of For affective disorders, such as bipolar disorder, total

expenditure was calculated at $US3062 per patient percareyear, compared with $US9288 per patient per year forAtypical antipsychotics are associated with higherschizoaffective disorders.†† Out-of-pocket expensesacquisition costs than conventional antipsychotics.incurred by patients, and their family members, totalledNevertheless, their use in the field is increasing. A study$US583 per patient per year for affective disorders.conducted by Dr Dennis Meletiche from JanssenCompared with the control cohort, annual per-patientPharmaceutica, US, and colleagues, compared resourceadditional expenditures for patients with affectiveuse and costs of care among patients receiving thedisorders were $US523 for prescription drugs, $US611atypical antipsychotics olanzapine, risperidone orfor office-based physician visits and $US1807 forquetiapine.2** The retrospective study identified 573inpatient visits.patients with a diagnosis of bipolar disorder in June

2001. Use of psychiatric health-specific resources and Substantial loss of incomeinpatient and outpatient services were analysed for 104 Annual income loss in patients with psychoticpatients with sufficient resource use information who disorders was significant, compared with controls, notereceived either olanzapine (n = 47), risperidone (29) or the researchers. Income losses associated with difficultyquetiapine (28) over the previous 6 months. in performing independent activities of daily living and

It was found that risperidone recipients used fewer cognitive, social and physical limitations were anoutpatient services than olanzapine and quetiapine estimated $US2630, $US2329, $US3092 and $US3714

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Inpharma 15 Jun 2002 No. 13421173-8324/10/1342-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

Single Article

Antipsychotics clearly beneficial in bipolar disorder – continuedannually per patient, respectively. Moreover, patients

Table. Costs and resource use for patients withwith psychotic disorders were 40% less likely thanbipolar disorder receiving atypical antipsychoticscontrols to be in full-time employment; the between-Mean Risperidone Olanzapine Quetiapinegroup difference was significant. Patients’ familycosts per (n = 29) (n = 47) (n = 28)members were also significantly less likely than controlspatientto be in full-time employment. Limitations in performing ($US)

independent activities of daily living were reported 20%Outpatient 1084 1733 1806more often in patients with psychotic disorders provider

compared with controls. visitsPsychiatric- 66 238 309Atypical antipsychotics improve healthrelatedstatus, income ER* visits

The study also showed that patients who were Psychiatric- 1903 4648 2332prescribed an atypical antipsychotic and their family related

hospitalisationsmembers paid $US452 less per year than thoseTotal** 4349 8579 5221prescribed a conventional antipsychotic; atypical

antipsychotic recipients were also 6% more likely than * emergency roomthose receiving conventional antipsychotics to report ** including ER visits and hospitalisations for reasons other than

psychiatricgood health status. In addition, patients who received anatypical antipsychotic were significantly less likely thanpatients who received conventional antipsychotics to

* Five of the researchers were affiliated with Eli Lilly Researchreport cognitive limitations, or limitations with Laboratories, US, which provided funding for the study.performing independent activities of daily living. ** Two of the researchers were affiliated with Janssen Pharmaceutica,Moreover, patients who received atypical US, which sponsored the study.antipsychotics, compared with those who received † Drug costs were not included in the analysis.conventional antipsychotics, accrued an increase in ‡ Two of the researchers were affiliated with AstraZenecaannual income of $US73 due to their improved mental Pharmaceuticals, which funded the study.health status, and $US421 annually due to their †† 1996 valuesimproved overall health status. An improvement in

1. Zhu B, et al. Economic outcomes associated with olanzapine versus divalproexcognitive ability in patients who received atypical treatment for acute mania: results from a randomized clinical trial. Value inHealth 5: 234-235 (plus poster), May-Jun 2002.antipsychotics yielded an additional $US361 annually,

2. Meletiche DM, et al. Utilization and cost of resources in bipolar patientsand the reduced need for assistance with activities of receiving atypical antipsychotics. Value in Health 5: 233 (plus poster), May-Jundaily life resulted in a further $US106 annually, 2002.

3. Simons WR, et al. The direct and indirect economic costs of psychotic disorderscompared with patients who received conventionalto both patients and caregivers. Value in Health 5: 229 (plus poster), May-Junantipsychotics. 2002.

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