Skip to main content
NCBI home page
Current Therapeutic Research, Clinical and Experimental logoLink to Current Therapeutic Research, Clinical and Experimental
. 2005 Sep;66(5):463–474. doi: 10.1016/j.curtheres.2005.10.004

Choice of atypical antipsychotic therapy for patients with schizophrenia: An analysis of a medicaid population

Gordon G Liu 1,2,*, Shawn X Sun 3, Dale B Christensen 1, Zhongyun Zhao 4
PMCID: PMC4003804  PMID: 24790246

Abstract

Background:

In patients treated at Veterans Affairs facilities, demographicand clinical characteristics have been found to influence the choice of atypical antipsychotic drugs. However, little is known about the influences on the choice between olanzapine and risperidone in patients with schizophrenia enrolled in Medicaid.

Objective:

The aim of this study was to determine whether demographicand/or clinical characteristics and/or medical-service utilization before treatment were related to the choice of olanzapine versus risperidone therapy using data from a Medicaid population with schizophrenia.

Methods:

The study sample was identified in the North Carolina (NC)Medicaid claims database. Data were included from patients aged 18 to 64 years who were diagnosed with schizophrenia; had initiated treatment with olanzapine or risperidone between July 1, 1998, and October 31, 2000; had not used atypical antipsychotics during the 6 months before the start of treatment; and were continuously eligible in the NC Medicaid program during the 6 months before the start of treatment. Multivariate logistic regression models were used to estimate the likelihood of the choice of olanzapine or risperidone associated with patients' demographic and clinical characteristics and medical-service utilization during the 6 months before the initiation of treatment.

Results:

A total of 764 patients (383 women, 381 men; mean age, 42.1 years)were included in the analysis: 420 were initially prescribed olanzapine and 344 were prescribed risperidone. Men were more likely than women to be prescribed olanzapine compared with risperidone. Patients who had a hospitalization related to a psychiatric condition during the pretreatment period were more likely to be prescribed olanzapine compared with risperidone (OR = 1.530; P = 0.043). Significant regional variation in the likelihood of prescribing olanzapine or risperidone was found, with patients being prescribed risperidone at a higher rate compared with olanzapine in 2 counties with the largest schizophrenic populations.

Conclusions:

In this study of data from patients with schizophrenia identified in the NC Medicaid claims database, sex, a history of psychiatric-related hospitalization, and geographic residence were found to be correlated with the selection of treatment with olanzapine versus risperidone. These findings need to be confirmed in large, randomized, prospective studies.

Key words: atypical antipsychotics, olanzapine, risperidone, schizophrenia, NC Medicaid

Full Text

The Full Text of this article is available as a PDF (729.3 KB).

References

  • 1.Thompson D. Cost of switching from neuroleptics to risperidone and clozapine: A pilot study of the San Diego County Mental Health Services. Clin Drug Invest. 1997;14:428–433. [Google Scholar]
  • 2.Viale G., Mechling L., Maislin G. Impact of risperidone on the use of mental health care resources. Psychiatr Serv. 1997;48:1153–1159. doi: 10.1176/ps.48.9.1153. [DOI] [PubMed] [Google Scholar]
  • 3.Carter C., Stevens M., Durkin M. Effects of risperidone therapy on the use of mental health care resources in Salt Lake County, Utah. Clin Ther. 1998;20:352–363. doi: 10.1016/s0149-2918(98)80099-4. [DOI] [PubMed] [Google Scholar]
  • 4.Nightengale B.S., Crumly J.M., Liao J. Economic outcomes of antipsychotic agents in a Medicaid population: Traditional agents vs. risperidone. Psychopharmacol Bull. 1998;34:373–382. [PubMed] [Google Scholar]
  • 5.Nightengale B.S., Garrett L., Waugh S. Economic outcomes associated with the use of risperidone in a naturalistic group practice setting. Am J Manag Care. 1998;4:360–366. [PubMed] [Google Scholar]
  • 6.Sacristdn J.A., Gómez J.C., Martin J. Pharmacoeconomic assessment of olanzapine in the treatment of refractory schizophrenia based on a pilot clinical study. Clin Drug Invest. 1998;15:29–35. doi: 10.2165/00044011-199815010-00004. [DOI] [PubMed] [Google Scholar]
  • 7.Hamilton S.H., Revicki D.A., Edgell E.T. Clinical and economic outcomes of olanzapine compared with haloperidol for schizophrenia. Results from a randomised clinical trial. PharmacoEconomics. 1999;15:469–480. doi: 10.2165/00019053-199915050-00005. [DOI] [PubMed] [Google Scholar]
  • 8.Schiller M.J., Shumway M., Hargreaves W.A. Treatment costs and patient outcomes with use of risperidone in a public mental health setting. Psychiatr Serv. 1999;50:228–232. doi: 10.1176/ps.50.2.228. [DOI] [PubMed] [Google Scholar]
  • 9.Tunis S.L., Johnstone B.M., Gibson P.J. Changes in perceived health and functioning as a cost-effectiveness measure for olanzapine versus haloperidol treatment of schizophrenia. J Clin Psychiatry. 1999;60(Suppl 19):38–45. [PubMed] [Google Scholar]
  • 10.Shermock K.M., Kay Sadik M., Kozma C.M. Risperidone, haloperidol and clozapine in the South Carolina Medicaid program: A comparative analysis of utilisation and expenditure. Dis Manag Health Outcomes. 2001;9:203–213. [Google Scholar]
  • 11.Del Paggio D., Finley P.R., Cavano J.M. Clinical and economic outcomes associated with olanzapine for the treatment of psychotic symptoms in a county mental health population. Clin Ther. 2002;24:803–817. doi: 10.1016/s0149-2918(02)85154-2. [DOI] [PubMed] [Google Scholar]
  • 12.Gianfrancesco F., Durkin M.B., Mahmoud R., Wang R.H. Use of healthcare services by patients treated with risperidone versus conventional antipsychotic agents. PharmacoEconomics. 2002;20:413–427. doi: 10.2165/00019053-200220060-00006. [DOI] [PubMed] [Google Scholar]
  • 13.Rosenheck R., Perlick D., Bingham S., Department of Veterans Affairs Cooperative Study Group on the Cost-Effectiveness of Olanzapine Effectiveness and cost of olanzapine and haloperidol in the treatment of schizophrenia: A randomized controlled trial. JAMA. 2003;290:2693–2702. doi: 10.1001/jama.290.20.2693. [DOI] [PubMed] [Google Scholar]
  • 14.Edgell E.T., Andersen S.W., Johnstone B.M. Olanzapine versus risperidone. A prospective comparison of clinical and economic outcomes in schizophrenia. PharmacoEconomics. 2000;18:567–579. doi: 10.2165/00019053-200018060-00004. [DOI] [PubMed] [Google Scholar]
  • 15.Zhao Z. A retrospective economic evaluation of olanzapine versus risperidone in the treatment of schizophrenia. Manag Care Interface. 2002;15:75–81. [PubMed] [Google Scholar]
  • 16.Rascati K.L., Johnsrud M.T., Crismon M.L. Olanzapine versus risperidone in the treatment of schizophrenia: A comparison of costs among Texas Medicaid recipients. PharmacoEconomics. 2003;21:683–697. doi: 10.2165/00019053-200321100-00001. [DOI] [PubMed] [Google Scholar]
  • 17.Lewis M., McCrone P., Frangou S. Service use and costs of treating schizophrenia with atypical antipsychotics. J Clin Psychiatry. 2001;62:749–756. doi: 10.4088/jcp.v62n1002. [DOI] [PubMed] [Google Scholar]
  • 18.Fuller M.A., Shermock K.M., Secic M. Service use and costs among VA patients with schizophrenia taking risperidone or olanzapine. Psychiatr Serv. 2002;53:855–860. doi: 10.1176/appi.ps.53.7.855. [DOI] [PubMed] [Google Scholar]
  • 19.Byerly M.J., Weber M., Brooks D. Cost evaluation of risperidone compared with olanzapine. Psychiatr Serv. 2003;54:742–744. doi: 10.1176/appi.ps.54.5.742. [DOI] [PubMed] [Google Scholar]
  • 20.Tran P.V., Hamilton S.H., Kuntz A.J. Double-blind comparison of olanzapine versus risperidone in the treatment of schizophrenia and other psychotic disorders. J Clin Psychopharmacol. 1997;17:407–418. doi: 10.1097/00004714-199710000-00010. [DOI] [PubMed] [Google Scholar]
  • 21.Conley R.R., Mahmoud R. A randomized double-blind study of risperidone and olanzapine in the treatment of schizophrenia or schizoaffective disorder. Am J Psychiatry. 2001;158:765–774. doi: 10.1176/appi.ajp.158.5.765. [published correction appears in Am J Psychiatry. 2001;158:1759] [DOI] [PubMed] [Google Scholar]
  • 22.Ho B.C., Miller D., Nopoulos P., Andreasen N.C. A comparative effectiveness study of risperidone and olanzapine in the treatment of schizophrenia. J Clin Psychiatry. 1999;60:658–663. doi: 10.4088/jcp.v60n1003. [DOI] [PubMed] [Google Scholar]
  • 23.Liu G.G., Sun S.X., Christensen D.B., Luo X. Cost comparisons of olanzapine and risperidone in treating schizophrenia. Ann Pharmacother. 2004;38:134–141. doi: 10.1345/aph.1C485. [DOI] [PubMed] [Google Scholar]
  • 24.Bobes J., Rejas J., Garcia-Garcia M., EIRE Study Group Weight gain in patients with schizophrenia treated with risperidone, olanzapine, quetiapine or haloperidol: Results of the EIRE study. Schizophr Res. 2003;62:77–88. doi: 10.1016/s0920-9964(02)00431-0. [DOI] [PubMed] [Google Scholar]
  • 25.Ascher-Svanum H., Stensland M., Zhao Z., Kinon B.J. Acute weight gain, gender, and therapeutic response to antipsychotics in the treatment of patients with schizophrenia. BMC Psychiatry. 2005;5:3. doi: 10.1186/1471-244X-5-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26.Leslie D.L., Rosenheck R. The effect of institutional fiscal stress on the use of atypical antipsychotic medications in the treatment of schizophrenia. J Nerv Ment Dis. 2001;189:377–383. doi: 10.1097/00005053-200106000-00005. [DOI] [PubMed] [Google Scholar]
  • 27.Yesavage J.A., Hoblyn J., Sheikh J. Age and disease severity predict choice of atypical neuroleptic: A signal detection approach to physicians' prescribing decisions. J Psychiatr Res. 2003;37:535–538. doi: 10.1016/s0022-3956(03)00053-0. [DOI] [PubMed] [Google Scholar]
  • 28.Ren X.S., Kazis L.E., Lee A.F. Patient characteristics and prescription patterns of atypical antipsychotics among patients with schizophrenia. J Clin Pharm Ther. 2002;27:441–451. doi: 10.1046/j.1365-2710.2002.00443.x. [DOI] [PubMed] [Google Scholar]
  • 29.North Carolina (NC) Medicaid claims database [Web site]. Available at: http://www/resdac.umn.edu.Accessed September 15, 2005.
  • 30.National Drug Codes [US Food and Drug Administration Web site]. Available at:http://www.fda.gov/cder/ndc/database/default.htm. Accessed September 15, 2005.
  • 31.Health Insurance Portability and Accountability Act [HIPAA Web site]. Available at:http://www.hipaa.org/. Accessed June 1, 2005.
  • 32.US Dept of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics (NCHS) NCHS; Hyattsville, Md: 2003. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) [Google Scholar]
  • 33.Opolka J.L., Rascati K.L., Brown C.M. Ethnic differences in use of antipsychotic medication among Texas Medicaid clients with schizophrenia. J Clin Psychiatry. 2003;64:635–639. doi: 10.4088/jcp.v64n0603. [DOI] [PubMed] [Google Scholar]
  • 34.McPherson K., Wennberg J.E., Hovind O.B., Clifford P. Small-area variations in the use of common surgical procedures: An international comparison of New England, England, and Norway. N Engl J Med. 1982;307:1310–1314. doi: 10.1056/NEJM198211183072104. [DOI] [PubMed] [Google Scholar]
  • 35.Citrome L., Levine J., Allingham B. Utilization of depot neuroleptic medication in psychiatric inpatients. Psychopharmacol Bull. 1996;32:321–326. [PubMed] [Google Scholar]

Articles from Current Therapeutic Research, Clinical and Experimental are provided here courtesy of Elsevier

RESOURCES