The Impact of Open Access to Atypical Antipsychotics on Treatment Costs for Medi-Cal Patients with Bipolar Disorder

Background

The California Medicaid Program (Medi-Cal) provided open access to atypical antipsychotics in October 1997. This study investigated the impact of open access to atypical antipsychotics on the costs and duration of therapy for patients with bipolar disorders.

Methods

Paid claims data from Medi-Cal were used to identify episodes of treatment using antipsychotics, antidepressants, mood stabilizers, or selected anticonvulsants initiated by patients with bipolar disorders. Episodes of treatment were assigned to one of three time periods based on the start date: closed access (July 1994 to September 1997); a transition period (October 1997 to March 1998); and open access (April 1998 to August 1999). Ordinary least squares models for the cost and duration of drug therapy were estimated for episodes of treatment started after a break in all bipolar-related drug therapy (restarts) and switching/augmentation episodes.

Results

123 796 restart and 206 157 switching/augmentation episodes were identified. Patients with bipolar disorders cost between $US8000 and $US9000 annually (year of values 1998). Open access increased total costs by $US165–203 per year for restart episodes and $US75–125 per year for switching/augmentation episodes, primarily due to increased drug costs of $US101–103 for restart episodes (p < 0.001) and $US124 for switching/augmentation episodes (p < 0.001). Days of therapy decreased by 3.67 days for restart episodes (p < 0.001) and increased by 2.59–2.62 days for switching/augmentation episodes (p < 0.001) from the closed access period to the open access period.

Conclusions

Conventional antipsychotic medications are not used for long-term drug therapy for bipolar disorders, and the long-term effectiveness of atypical antipsychotics was not well established in October 1997. It is not surprising that open access to atypical antipsychotics had only limited effects on the costs and duration of therapy for these patients.

     

医保与非医保患者急性阑尾炎住院费用分析

目的 对医疗保险与非医疗保险住院患者医疗费用进行比较、分析医保病例的费用特点及相应的费用控制办法。方法 以急性单纯性阑尾炎患者为研究对象，运用协方差分析和秩和检验分析医保与非医保患者的费用情况和费用的年度变化趋势。结果 在急性单纯性阑尾炎治疗费用上，医保患者的费用高于非医保患者，且有显著性差异：医保患者的收费呈现年度递增趋势，有显著性差异。结论 政府应采取价格控制，改革供方支付方式，完善医疗保险管理体制，从而有效地控制医疗费用。     

Health Care Utilization and Costs in Patients with Generalized Anxiety Disorder Initiating Add-on Therapy with Benzodiazepines

ObjectivesTo examine patterns of health care utilization and costs in patients with generalized anxiety disorder (GAD) who begin treatment with benzodiazepine anxiolytics as add-on therapy.Study DesignIn a large US health insurance database, we identified all patients with evidence of GAD (International Classification of Diseases, 9^th Revision, Clinical Modification diagnosis code 300.02) who received ≥90 days of therapy with a selective serotonin reuptake inhibitor or venlafaxine between January 1, 2003 and December 31, 2007. Among these patients, we selected those who initiated a course of benzodiazepine add-on therapy. Designating the date of initial receipt of a benzodiazepine as the “index date,” we examined health care utilization and costs over the 6-month period preceding this date (“pre-index”) and the 12-month period following it (“follow-up”).ResultsA total of 2131 patients met all study inclusion criteria. Patients averaged 32 days of therapy with benzodiazepines (median [interquartile range] = 20 [10-30]); 13% of patients received >90 days of therapy, however. In general, levels of health care utilization during the first 6 months of follow-up were higher than those during the pre-index period; between months 7 and 12 of follow-up, however, they were somewhat lower than pre-index levels. Mean (SD) total health care costs were $5148 ($10,658), $6325 ($15,741), and $5373 ($11,230) during pre-index, months 1-6 of follow-up, and months 7-12 of follow-up, respectively.ConclusionsLevels of health care utilization and costs increase following initiation of add-on therapy with a benzodiazepine in patients with GAD receiving selective serotonin reuptake inhibitors or venlafaxine. Although duration of add-on therapy is typically brief, some patients are treated for >90 days, raising potential concerns about risks of dependency and sedation.     

心脏起搏器植入患者住院费用及影响因素分析

目的分析心脏起搏器植入患者住院费用构成及影响因素，为合理控制心脏起搏器植入患者住院费用提供参考。方法采用描述性分析、非参数检验和多元线性回归等方法，对上海市某三甲医院2017年5月1日-2019年6月1日出院的660例心脏起搏器植入患者的住院费用进行分析。结果心脏起搏器植入患者平均住院总费用为（81 396.26±26 063.39）元，卫生材料费、化验费和治疗费是患者住院总费用的主要构成。多因素分析发现，住院天数是影响住院费用的首要因素。结论心脏起搏器植入患者住院费用总体偏高。应完善医保支付方式，降低卫生材料费；缩短平均住院日，加快床位周转；调整相关医疗服务价格，体现医务人员技术劳动价值；定期随访出院患者，关注生活质量改善。     

Psychoeducational Approaches to Medication Adherence in Patients with Bipolar Disorder

There is growing consensus that a major obstacle to good outcomes among individuals with bipolar disorder (BPD) is premature discontinuation of medications. This review summarizes the current literature on prevalence and consequences of non-adherence in BPD populations, measurement of adherence, risk factors for non-adherence, and general and psychoeducational interventions to enhance treatment adherence among bipolar populations, and suggests future directions in psychoeducational approaches with respect to treatment adherence. Risks associated with discontinuation of medication among individuals with BPD are well documented and include manic and depressive relapses, re-hospitalization, and more lengthy hospital stays. A relatively limited but growing literature suggests that it is possible to enhance treatment adherence among patients with BPD. The most positive evidence for the improvement of medication adherence among patients with BPD comes from specific psychosocial interventions used in conjunction with pharmacotherapies. It has been suggested that improved treatment adherence is at least a partial component of the observed positive outcomes of psychoeducational approaches among bipolar populations. Many individuals with BPD remain relatively uninformed regarding their illness, creating potential barriers to optimal treatment adherence, and limiting self-management skills. Psychoeducation is based on the premise that individuals have a fundamental right to have information regarding their illness, and individuals who are informed are more likely to take a more active role in managing their illness, which results in better health outcomes. Psychoeducation strategies for BPD that have contributed to positive outcomes have ranged from simple one-site, education-only interventions that improve lithium adherence and attitudes about medications to a more complex, multi-site, collaborative care system intervention that yielded shorter durations of affective episodes for patients, improved functioning and quality of life, and treatment satisfaction. Although psychological therapies that emphasize psychoeducation generally support benefits in achieving and maintaining remission from bipolar symptoms, the effects of these interventions on treatment adherence are not consistent and the way in which psychoeducation improves outcomes is not entirely clear. There is an urgent need for greater understanding of interventions that can be implemented in real-world settings that address patient, provider/system, and environmental/social factors that are critical to treatment adherence.     

生活方式干预在双相情感障碍合并代谢综合征患者中的应用

目的 探讨生活方式干预在双相情感障碍(BD)合并代谢综合征(MS)患者中的应用应用效果.方法 收集2016—2019年沈阳市铁西区精神卫生中心收治的BD合并MS患者50例,随机分为对照组和观察组各25例.对照组采用常规护理模式,观察组采用生活方式干预.比较干预3个月后两组患者的自我效能改善情况和MS相关指标变化情况.结...     

深圳市乙型病毒性肝炎病例住院费用分析

目的 分析乙型病毒性肝炎各临床分型的住院费用与影响因素. 方法 通过收集一家哨点医院2009-2010年病案系统数据,对多种乙型肝炎临床分型的病案数据汇总,运用SPSS15.0对病例流行病学特征和住院费用进行分析. 结果 2009-2010年共监测乙型病毒性肝炎以及相关住院病例共2765例,病例主要缴费方式以社会医疗保险为主;平均住院天数为(13.6±2.0)d;住院肝炎病例人均总住院费用几何均数(9963.63±2.10)元,日均总费用的几何均数为(732.16±1.51)元,急性乙肝的住院费用和日均住院费用均比慢性肝高,日均住院费用则为肝硬化伴食管静脉曲张病例＞肝硬化病例＞肝纤维化病例,肝癌病例的住院费用和日均住院费用均高于其它临床分型;西药费、化验费和诊疗费在总费用中所占比例较大;高年龄、住院天数多、病情较重、合并其它肝脏疾病、手术和自费缴费均提高总住院费用. 结论 加强疫苗接种,特别是阻断母婴传播和幼儿感染,降低慢性化,对重点人群开展综合监测和预防控制是深圳未来降低肝炎疾病和经济负担的重要手段.     

扁桃体切除术患者住院费用影响因素分析

目的 研究扁桃体切除术患者住院费用影响因素,探讨降低医疗费用的方法.方法 回顾性分析164例扁桃体切除术住院患者病案,对住院费用构成、变化及影响因素等进行分析.结果 影响住院费用的主要因素为：麻醉方法、合并非常规检查、年龄、传统剥离术联合电凝止血、电刀切除术、多个诊断、手术时间、术后住院天数、术前住院天数、传统剥离术等.结论 控制扁桃体手术住院费用的可能措施有：控制药品和材料费用,加强临床用药和麻醉用药管理,降低全麻费用,缩短手术时间,适当增加门诊检查报销比例,减少住院天数尤其是术前住院天数等.     

Atypical Antipsychotics and Metabolic Syndrome in Patients with Schizophrenia: Risk Factors,Monitoring, and Healthcare Implications

Background

Metabolic syndrome is a leading cause of morbidity and mortality in patients with schizophrenia, with a prevalence rate double that of nonpsychiatric populations. Given the amount of evidence suggesting a link between atypical antipsychotic medications and metabolic syndrome, several agencies have recommended regular clinical monitoring of weight, symptoms of hyperglycemia, and glucose in chronically medicated patients with schizophrenia.

Objectives

To summarize the current literature on atypical antipsychotic-induced metabolic syndrome in patients with schizophrenia, outline some of the molecular mechanisms behind this syndrome, identify demographic and disease-related risk factors, and describe cost-effective methods for surveillance.

Discussion

The differential prevalence of metabolic syndrome associated with various atypical antipsychotic medications has been evidenced across numerous studies, with higher effects seen for certain antipsychotic medications on weight gain, waist circumference, fasting triglyceride level, and glucose levels. Given the association of these symptoms, all atypical antipsychotic medications currently include a warning about the risk of hyperglycemia and diabetes, as well as suggestions for regular monitoring. Despite this, very little data are available to support adherence to these monitoring recommendations. Lack of awareness and resources, diffusion of responsibility, policy implementation, and organizational structure have all been implicated.

Conclusion

The treatment of schizophrenia involves a balance in terms of risks and benefits. Failing to treat because of risk for complications from metabolic syndrome may place the patient at a higher risk for more serious health outcomes. Supporting programs aimed at increasing monitoring of simple laboratory and clinical measures associated with metabolic syndrome may decrease important risk factors, improve patients'' quality of life, and reduce healthcare costs.Despite treatment advances in prevention, cardiovascular disease (CVD) remains the leading cause of mortality globally. CVD is responsible for 30% of all deaths and represents one of the leading long-term health considerations in the population as a whole.1 CVD is also the most common cause of natural mortality in schizophrenia, accounting for a total of 34% of deaths among male patients and 31% of deaths in female patients and is surpassed only by suicide.2 In fact, it has been estimated that the prevalence of dyslipidemia, hypertension, obesity, and type 2 diabetes is approximately 1.5 to 2 times higher in individuals with schizophrenia and other serious mental illness compared with the general population.3 Although the exact prevalence of metabolic syndrome in adults with schizophrenia varies greatly (between 20% and 60%), common estimates typically place this at twice that of the normal healthy population.4     

医保患者住院费用及影响因素

摘要》目的：探讨住院医保患者医保费用逐年增高的因素。方法：调查2008年、2009年和2010年我院住院患者的医保费用及其影响的相关因素,结果; 如能正确处理好这些因素,就能减少医保费用。结论：住院费用减少,就能减少患者支出,降低医院亏损,使医保事业及医院建设持续发展     

新农合大病医保对乳腺癌患者住院费用影响的调查分析

目的 了解河南省新农合大病医保政策试点工作一年来实施效果.方法 利用河南省某三甲肿瘤专科医院200例乳腺癌患者住院费等数据进行分析.结果 新农合大病医保政策实施后,患者次均实际补偿费用增加、住院天数减少、检查费减少及治疗费增加,其变化差异有统计学意义;而住院费用、次均可报销费用及药品费在该政策实施后变化差异无统计学意义.结论 该政策的实施对遏制住院费用的增长有一定作用,对解决农村居民“看病难,看病贵”问题起到了积极作用.应加强对定点医疗机构的监督管理,合理制定限额支付金额,将次均费用及其增长幅度、平均住院日、目录内药品使用比例等指标纳入大病医保费用控制范围,还应充分发挥商业医疗保险机构作用.     

罗伊适应模式护理在重复经颅磁刺激治疗双相情感障碍稳定期女性患者中的应用

目的 探讨罗伊适应模式护理在重复经颅磁刺激治疗双相情感障碍稳定期女性患者中的应用效果.方法 95例采用重复经颅磁刺激治疗的双相情感障碍稳定期女性患者随机分为两组,对照组47例给予常规护理,观察组48例在对照组基础上给予罗伊适应模式护理,比较两组的BMRS评分和生存质量.结果 干预后,观察组的BMRS评分低于对照组,环境...     

Bipolar Disorder in Women

This article summarizes research pertinent to the clinical care of women with bipolar disorder. With bipolar disorder, female gender correlates with more depressive symptoms and different comorbidities. There is a high risk of symptom recurrence postpartum and possibly during perimenopause. Women with bipolar disorder have increased risk of sexually transmitted diseases, unplanned pregnancies, excessive weight gain, metabolic syndrome, and cardiovascular disease. Mood stabilizing medications, specific psychotherapies, and lifestyle changes can stabilize mood and improve functioning. Pharmacologic considerations include understanding interactions between mood stabilizing medications and contraceptive agents and risks and benefits of mood stabilizing medication during pregnancy and lactation.