- Email: [email protected]
Treatment Patterns In Medicaid Beneficiaries With Schizophrenia Reaching Stabilized Maintenance With Once-Monthly Paliperidone Palmitate Therapy
A196
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 1 - A 3 1 8
children, the increased use is linked to increased morbidity rather than differences in treatment patterns. PMH78 An Assessment Of Follow-Up Visits And Use Of Psychosocial Services Among Foster And Non-Foster Children Starting Antipsychotic Therapy Shah R1, Ramachandran S1, Nunna S1, Banahan III B1, Hardwick S1, Noble S2 1University of Mississippi, University, MS, USA, 2Office of the Governor, Division of Medicaid, Jackson, MS, USA
Objectives: In 2013, the National Collaborative for Innovation in Quality Measurement (NCINQ) proposed three quality measures to assess the use of needed services associated with antipsychotic medication use among children enrolled in Medicaid and CHIP programs. The measures addressed follow-up care after starting an antipsychotic (AP), psychosocial care during antipsychotic use, and metabolic monitoring. Performance on the first two proposed measures was conducted for Mississippi Medicaid beneficiaries. Methods: A retrospective analysis of Mississippi Medicaid administrative claims data from January 1, 2014 through December 31, 2014 was performed. The denominator for follow-up care and access to psychosocial care measure included beneficiaries ages 0 to 20 years continuously enrolled for > 3 months who had a new AP prescription during 2014. The numerator for the follow-up care measure included those children with one or more follow-up care visits within 30 days of new AP prescriptions. The numerator for the psychosocial care measure included beneficiaries who had received any psychosocial care during 2014. Results: The denominator for follow-up visits and psychosocial care measure included 4,236 beneficiaries. Overall 56.3% of children starting antipsychotic therapy received one or more follow-up care visits. Rates for foster children (57.6%) and non-foster children (56.2%) were not significantly different. Overall 63.4% of children taking antipsychotics received some form of psychosocial care during the measurement period. Rates for foster children (63.6%) and non-foster children (60.9%) did not differ significantly. Conclusions: The performance rates were not significantly different between foster and non-foster children, indicating that care for foster children is comparable to that for non-foster children. However, overall rates for both follow-up visits and access to psychosocial care services demonstrate a need for improvement in order to assure appropriate monitoring of children prescribed antipsychotics. PMH79 Dangers Of The World-Wide Web On The Doorstep Of Adolescence Karácsony I1, Nemes AÁ1, Oláh A2, Boncz I2, Ferenczy M1, Müller Á2, Brantmüller É3, Pakai A4 of Pécs, Szombathely, Hungary, 2University of Pécs, Pécs, Hungary, 3University of Pécs, Kaposvár, Hungary, 4University of Pécs, Zalaegerszeg, Hungary 1University
Objectives: Today the virtual space has become the stage of communication for the juveniles. Abuse has also appeared in the cyber space. Throughout our research, we were interested in the victimization in the cyber space and what factors correlate with the appearance of the problem. Methods: Our research was taken place in Vas County (Hungary) using individually designed questionnaires among 146 high school students between January and February 2015. Throughout the data processing, using descriptive statistical methods, two variants were concerned. Results: Juveniles connect to cyber-space on a daily basis which aims at community based activities (87%), entertainment (84%), learning (70%), computer games (51%), and establishing new relationships (18%). Computer as a new element appears in the relationships of juveniles which has a descending effect on the number of friends being present. As the stage of relationship has been changing, the stage of abusing has been also changing in direct ratio; increased presence in the virtual space - increased abuse in the world of web. Students were abused in the last four months in the offline space (31%) as well as in the online space (39%). Besides the increasing tendency, on the given individual the effects of both cumulate (p< 0,05). 58% of the questioned teenagers break age related rules and in these cases online victimization increases (p< 0,05). 70% of the parents do not control any activities of their children at all during their computer usage. Conclusions: Besides the positive effects of the online space, it stenghtens negative effects as well. 2/3 of the victimized individuals also meet abuse in the real space, which shows correlation with the abuse of visiting web pages with age limitation, on which parental control has effect as we have proved. PMH80 Assessing Factors Associated With Antipsychotic Polypharmacy In The Texas Medicaid Population Desai PR1, Lawson KA2, Richards KM3, Rascati K2, Barner JC2, Miller A4 1Amgen Inc., Thousand Oaks, CA, USA, 2The University of Texas at Austin, Austin, TX, USA, 3University of Texas at Austin College of Pharmacy, Austin, TX, USA, 4University of Texas Health Science Center, San Antonio, TX, USA
Objectives: To identify characteristics associated with antipsychotic polypharmacy (APP) in the Texas Medicaid population. Methods: Adults newly initiated on antipsychotics between July 1, 2006 and December 31, 2010 were followed for 365 days after the index antipsychotic claim (index date). APP was defined as the concomitant use of two or more antipsychotics for at least 60 days without a gap in polypharmacy greater than 31 days. Monotherapy (MT) was defined as exposure to no more than one antipsychotic at a time during the 1-year post-index period. A logistic regression was conducted to identify characteristics associated with APP; presence of APP (yes/no) was the dependent variable, and demographic, clinical, physician, and prior utilization characteristics were independent variables. Results: Of the 23,232 eligible patients, 5.4% were on APP and 94.6% on MT during the study period. Older patients (Odds ratio [OR]= 1.01) and males (OR= 1.14) were more likely to have APP. Patients with bipolar disorder, depression, other mental health diagnoses, multiple mental health diagnoses, and no mental health diagnoses were 44%, 59%, 43%, 53%, and 45%, respectively, less likely to have APP compared to those with schizophrenia/schizoaffective disorder. Those with current substance abuse were 22% less likely to have APP. A 1-unit increase in number of
unique mental illnesses increased the likelihood of APP 1.13 times, while a 1-point increase in pre-index Chronic Disease Score decreased the likelihood of APP by 6%. Use of psychotropic and anticholinergic drugs increased the likelihood of APP 1.40 and 2.76 times, respectively. Conclusions: Identifying predictors of APP could help providers and payers identify patients likely to be prescribed APP early on during the course of their illness. These patients can then be carefully monitored to determine if they are in fact appropriate candidates for APP and managed to ensure they do not experience negative health outcomes. PMH81 Persistence And Concomitant Drug Use On Branded Desvenlafaxine Compared With Other Antidepressants In Patients With Major Depressive Disorder Shelbaya A1, Deshpande C2, Pappadopulos E3, Alvir J3, Chirikov V2, Stephens JM2 1Pfizer Inc, Columbia University Mailman School of Public Health, New York, NY, USA, 2Pharmerit International, Bethesda, MD, USA, 3Pfizer Inc, New York, NY, USA
Objectives: To compare medication persistence and concomitant MDD drug use in patients prescribed i) branded desvenlafaxine, ii) other branded selective serotonin re-uptake inhibitors (SSRIs) and selective serotonin-norepinephrine re-uptake inhibitors (SNRIs), and iii) generic SSRIs/SNRIs (escitalopram, venlafaxine, citalopram, fluvoxamine, sertraline, fluoxetine and paroxetine). Methods: MDD patients (ICD-9-CM codes 296.2, 296.3) with ≥ 2 prescription fills for branded desvenlafaxine or other SSRIs/SNRIs and 12 months continuous enrollment pre-index (where first fill date was index date) were identified from the MarketScan Commercial Claims and Encounters Database (2009-2013). Treatment persistence (time to treatment discontinuation, defined as a prescription gap≥ 45 days) was assessed using KaplanMeier curves and Cox proportional model. Concomitant drug use among study groups was examined. Results: Of 273,514 identified patients, 14,379 initiated branded desvenlafaxine (mean age 46 years; 30% with psychiatric comorbidities [PC]), 50,937 other branded SSRIs/SNRIs (48 years; 31% PC), and 208,198 generic SSRIs/ SNRIs (47 years; 29% PC). Median time to discontinuation for branded desvenlafaxine was longer than either branded or generic SSRIs/SNRIs groups (40.7 [95% CI: 39.3, 42.0] vs. 28.9 [28.4, 29.1] vs. 33.4 [33.1, 33.7] weeks). After adjustment, patients treated with other branded SSRIs/SNRIs (HR= 1.31, P < 0.001) or generic SSRIs/SNRIs (HR= 1.11, P < 0.001) were more likely to discontinue than branded desvenlafaxine patients. Concomitant drug use was higher among branded desvenlafaxine (44%) compared to other branded (40%) and generic (36%) SSRIs/SNRIs groups. The most frequent concomitant drugs used were atypical antidepressants alone (37%), followed by antipsychotics alone (18%). Conclusions: Patients prescribed branded desvenlafaxine were more persistent than other branded or generic SSRIs/SNRIs groups and had a higher prevalence of concomitant drug use than other patients. The higher concomitant drug use did not appear to be driven by differences in psychiatric comorbidity burden. Results suggest a better ability to stay on treatment with branded desvenlafaxine compared to other SSRI/SNRI medications. PMH82 Treatment Patterns In Medicaid Beneficiaries With Schizophrenia Reaching Stabilized Maintenance With Once-Monthly Paliperidone Palmitate Therapy Pilon D1, Muser E2, Emond B1, Xiao Y1, Amos T2, Lefebvre P1, Benson C2 1Groupe d’analyse, Ltée, Montreal, QC, Canada, 2Janssen Scientific Affairs, LLC, Titusville, NJ, USA
Objectives: With the FDA approval (05/19/2015) of a once-every-3-month paliperidone palmitate formulation (PP3M), this study aimed to describe treatment patterns among once-monthly paliperidone palmitate (PP1M)-treated patients with schizophrenia reaching stabilized maintenance therapy that may be candidates for PP3M. Methods: Medicaid data (07/2008-03/2014) from FL, IA, KS, MO, MS, and NJ were used to identify adult beneficiaries initiated on PP1M with schizophrenia. Reaching stabilized maintenance therapy was defined as having ≥ 3 consecutive PP1M claims with the same dose strength beyond the first two initiation doses and ≤ 60 days between claims. Treatment patterns from the first (index date) to the last available PP1M claim were assessed using descriptive statistics and compared using the Wilcoxon test. Results: Among 4,482 PP1M users that met study inclusion criteria, 2,012 (45%) reached stabilized maintenance. Of those reaching stabilized maintenance, 868 (43%) and 510 (25%) had ≥ 8 and ≥ 12 consecutive PP1M claims, respectively, with the same dose strength beyond the first two initiation doses. The most frequently observed first and second claim dose combination for PP1M patients reaching stabilized maintenance was 234 mg followed by 156 mg (28%), consistent with the FDA approved initiation regimen. The most common stabilized maintenance dose was 156 mg (40%), followed by 117 mg (33%), and 234 mg (24%). Mean time from PP1M initiation to reaching stabilized maintenance was 118 days (standard deviation [SD]= 28, median= 114) and mean duration on stabilized maintenance therapy was 282 days (SD= 246, median= 191). Patients receiving the initiation regimen of 234 mg followed by 156 mg had a shorter mean time to reach stabilized maintenance (105 days [SD= 30, median= 98] vs. 123 days [SD= 25, median= 118] for all other dose combinations, P< 0.001). Conclusions: Forty-five percent of schizophrenia patients initiated on PP1M reached stabilized maintenance and time to reach stabilized maintenance therapy was faster when the FDA approved initiation regimen was followed.
RESEARCH POSTER PRESENTATIONS – SESSION IV DISEASE - SPECIFIC STUDIES DIABETES/ENDOCRINE DISORDERS – Clinical Outcomes Studies PDB1 COMPARATIVE SAFETY OF SGLT2 AND DPP-4 INHIBITORS ON RISK OF ADVERSE EVENTS IN MIDDLE-AGED ADULTS WITH TYPE 2 DIABETES MELLITUS Parente A , Kim S , Jones B T .
.
.
.
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 1 - A 3 1 8
children, the increased use is linked to increased morbidity rather than differences in treatment patterns. PMH78 An Assessment Of Follow-Up Visits And Use Of Psychosocial Services Among Foster And Non-Foster Children Starting Antipsychotic Therapy Shah R1, Ramachandran S1, Nunna S1, Banahan III B1, Hardwick S1, Noble S2 1University of Mississippi, University, MS, USA, 2Office of the Governor, Division of Medicaid, Jackson, MS, USA
Objectives: In 2013, the National Collaborative for Innovation in Quality Measurement (NCINQ) proposed three quality measures to assess the use of needed services associated with antipsychotic medication use among children enrolled in Medicaid and CHIP programs. The measures addressed follow-up care after starting an antipsychotic (AP), psychosocial care during antipsychotic use, and metabolic monitoring. Performance on the first two proposed measures was conducted for Mississippi Medicaid beneficiaries. Methods: A retrospective analysis of Mississippi Medicaid administrative claims data from January 1, 2014 through December 31, 2014 was performed. The denominator for follow-up care and access to psychosocial care measure included beneficiaries ages 0 to 20 years continuously enrolled for > 3 months who had a new AP prescription during 2014. The numerator for the follow-up care measure included those children with one or more follow-up care visits within 30 days of new AP prescriptions. The numerator for the psychosocial care measure included beneficiaries who had received any psychosocial care during 2014. Results: The denominator for follow-up visits and psychosocial care measure included 4,236 beneficiaries. Overall 56.3% of children starting antipsychotic therapy received one or more follow-up care visits. Rates for foster children (57.6%) and non-foster children (56.2%) were not significantly different. Overall 63.4% of children taking antipsychotics received some form of psychosocial care during the measurement period. Rates for foster children (63.6%) and non-foster children (60.9%) did not differ significantly. Conclusions: The performance rates were not significantly different between foster and non-foster children, indicating that care for foster children is comparable to that for non-foster children. However, overall rates for both follow-up visits and access to psychosocial care services demonstrate a need for improvement in order to assure appropriate monitoring of children prescribed antipsychotics. PMH79 Dangers Of The World-Wide Web On The Doorstep Of Adolescence Karácsony I1, Nemes AÁ1, Oláh A2, Boncz I2, Ferenczy M1, Müller Á2, Brantmüller É3, Pakai A4 of Pécs, Szombathely, Hungary, 2University of Pécs, Pécs, Hungary, 3University of Pécs, Kaposvár, Hungary, 4University of Pécs, Zalaegerszeg, Hungary 1University
Objectives: Today the virtual space has become the stage of communication for the juveniles. Abuse has also appeared in the cyber space. Throughout our research, we were interested in the victimization in the cyber space and what factors correlate with the appearance of the problem. Methods: Our research was taken place in Vas County (Hungary) using individually designed questionnaires among 146 high school students between January and February 2015. Throughout the data processing, using descriptive statistical methods, two variants were concerned. Results: Juveniles connect to cyber-space on a daily basis which aims at community based activities (87%), entertainment (84%), learning (70%), computer games (51%), and establishing new relationships (18%). Computer as a new element appears in the relationships of juveniles which has a descending effect on the number of friends being present. As the stage of relationship has been changing, the stage of abusing has been also changing in direct ratio; increased presence in the virtual space - increased abuse in the world of web. Students were abused in the last four months in the offline space (31%) as well as in the online space (39%). Besides the increasing tendency, on the given individual the effects of both cumulate (p< 0,05). 58% of the questioned teenagers break age related rules and in these cases online victimization increases (p< 0,05). 70% of the parents do not control any activities of their children at all during their computer usage. Conclusions: Besides the positive effects of the online space, it stenghtens negative effects as well. 2/3 of the victimized individuals also meet abuse in the real space, which shows correlation with the abuse of visiting web pages with age limitation, on which parental control has effect as we have proved. PMH80 Assessing Factors Associated With Antipsychotic Polypharmacy In The Texas Medicaid Population Desai PR1, Lawson KA2, Richards KM3, Rascati K2, Barner JC2, Miller A4 1Amgen Inc., Thousand Oaks, CA, USA, 2The University of Texas at Austin, Austin, TX, USA, 3University of Texas at Austin College of Pharmacy, Austin, TX, USA, 4University of Texas Health Science Center, San Antonio, TX, USA
Objectives: To identify characteristics associated with antipsychotic polypharmacy (APP) in the Texas Medicaid population. Methods: Adults newly initiated on antipsychotics between July 1, 2006 and December 31, 2010 were followed for 365 days after the index antipsychotic claim (index date). APP was defined as the concomitant use of two or more antipsychotics for at least 60 days without a gap in polypharmacy greater than 31 days. Monotherapy (MT) was defined as exposure to no more than one antipsychotic at a time during the 1-year post-index period. A logistic regression was conducted to identify characteristics associated with APP; presence of APP (yes/no) was the dependent variable, and demographic, clinical, physician, and prior utilization characteristics were independent variables. Results: Of the 23,232 eligible patients, 5.4% were on APP and 94.6% on MT during the study period. Older patients (Odds ratio [OR]= 1.01) and males (OR= 1.14) were more likely to have APP. Patients with bipolar disorder, depression, other mental health diagnoses, multiple mental health diagnoses, and no mental health diagnoses were 44%, 59%, 43%, 53%, and 45%, respectively, less likely to have APP compared to those with schizophrenia/schizoaffective disorder. Those with current substance abuse were 22% less likely to have APP. A 1-unit increase in number of
unique mental illnesses increased the likelihood of APP 1.13 times, while a 1-point increase in pre-index Chronic Disease Score decreased the likelihood of APP by 6%. Use of psychotropic and anticholinergic drugs increased the likelihood of APP 1.40 and 2.76 times, respectively. Conclusions: Identifying predictors of APP could help providers and payers identify patients likely to be prescribed APP early on during the course of their illness. These patients can then be carefully monitored to determine if they are in fact appropriate candidates for APP and managed to ensure they do not experience negative health outcomes. PMH81 Persistence And Concomitant Drug Use On Branded Desvenlafaxine Compared With Other Antidepressants In Patients With Major Depressive Disorder Shelbaya A1, Deshpande C2, Pappadopulos E3, Alvir J3, Chirikov V2, Stephens JM2 1Pfizer Inc, Columbia University Mailman School of Public Health, New York, NY, USA, 2Pharmerit International, Bethesda, MD, USA, 3Pfizer Inc, New York, NY, USA
Objectives: To compare medication persistence and concomitant MDD drug use in patients prescribed i) branded desvenlafaxine, ii) other branded selective serotonin re-uptake inhibitors (SSRIs) and selective serotonin-norepinephrine re-uptake inhibitors (SNRIs), and iii) generic SSRIs/SNRIs (escitalopram, venlafaxine, citalopram, fluvoxamine, sertraline, fluoxetine and paroxetine). Methods: MDD patients (ICD-9-CM codes 296.2, 296.3) with ≥ 2 prescription fills for branded desvenlafaxine or other SSRIs/SNRIs and 12 months continuous enrollment pre-index (where first fill date was index date) were identified from the MarketScan Commercial Claims and Encounters Database (2009-2013). Treatment persistence (time to treatment discontinuation, defined as a prescription gap≥ 45 days) was assessed using KaplanMeier curves and Cox proportional model. Concomitant drug use among study groups was examined. Results: Of 273,514 identified patients, 14,379 initiated branded desvenlafaxine (mean age 46 years; 30% with psychiatric comorbidities [PC]), 50,937 other branded SSRIs/SNRIs (48 years; 31% PC), and 208,198 generic SSRIs/ SNRIs (47 years; 29% PC). Median time to discontinuation for branded desvenlafaxine was longer than either branded or generic SSRIs/SNRIs groups (40.7 [95% CI: 39.3, 42.0] vs. 28.9 [28.4, 29.1] vs. 33.4 [33.1, 33.7] weeks). After adjustment, patients treated with other branded SSRIs/SNRIs (HR= 1.31, P < 0.001) or generic SSRIs/SNRIs (HR= 1.11, P < 0.001) were more likely to discontinue than branded desvenlafaxine patients. Concomitant drug use was higher among branded desvenlafaxine (44%) compared to other branded (40%) and generic (36%) SSRIs/SNRIs groups. The most frequent concomitant drugs used were atypical antidepressants alone (37%), followed by antipsychotics alone (18%). Conclusions: Patients prescribed branded desvenlafaxine were more persistent than other branded or generic SSRIs/SNRIs groups and had a higher prevalence of concomitant drug use than other patients. The higher concomitant drug use did not appear to be driven by differences in psychiatric comorbidity burden. Results suggest a better ability to stay on treatment with branded desvenlafaxine compared to other SSRI/SNRI medications. PMH82 Treatment Patterns In Medicaid Beneficiaries With Schizophrenia Reaching Stabilized Maintenance With Once-Monthly Paliperidone Palmitate Therapy Pilon D1, Muser E2, Emond B1, Xiao Y1, Amos T2, Lefebvre P1, Benson C2 1Groupe d’analyse, Ltée, Montreal, QC, Canada, 2Janssen Scientific Affairs, LLC, Titusville, NJ, USA
Objectives: With the FDA approval (05/19/2015) of a once-every-3-month paliperidone palmitate formulation (PP3M), this study aimed to describe treatment patterns among once-monthly paliperidone palmitate (PP1M)-treated patients with schizophrenia reaching stabilized maintenance therapy that may be candidates for PP3M. Methods: Medicaid data (07/2008-03/2014) from FL, IA, KS, MO, MS, and NJ were used to identify adult beneficiaries initiated on PP1M with schizophrenia. Reaching stabilized maintenance therapy was defined as having ≥ 3 consecutive PP1M claims with the same dose strength beyond the first two initiation doses and ≤ 60 days between claims. Treatment patterns from the first (index date) to the last available PP1M claim were assessed using descriptive statistics and compared using the Wilcoxon test. Results: Among 4,482 PP1M users that met study inclusion criteria, 2,012 (45%) reached stabilized maintenance. Of those reaching stabilized maintenance, 868 (43%) and 510 (25%) had ≥ 8 and ≥ 12 consecutive PP1M claims, respectively, with the same dose strength beyond the first two initiation doses. The most frequently observed first and second claim dose combination for PP1M patients reaching stabilized maintenance was 234 mg followed by 156 mg (28%), consistent with the FDA approved initiation regimen. The most common stabilized maintenance dose was 156 mg (40%), followed by 117 mg (33%), and 234 mg (24%). Mean time from PP1M initiation to reaching stabilized maintenance was 118 days (standard deviation [SD]= 28, median= 114) and mean duration on stabilized maintenance therapy was 282 days (SD= 246, median= 191). Patients receiving the initiation regimen of 234 mg followed by 156 mg had a shorter mean time to reach stabilized maintenance (105 days [SD= 30, median= 98] vs. 123 days [SD= 25, median= 118] for all other dose combinations, P< 0.001). Conclusions: Forty-five percent of schizophrenia patients initiated on PP1M reached stabilized maintenance and time to reach stabilized maintenance therapy was faster when the FDA approved initiation regimen was followed.
RESEARCH POSTER PRESENTATIONS – SESSION IV DISEASE - SPECIFIC STUDIES DIABETES/ENDOCRINE DISORDERS – Clinical Outcomes Studies PDB1 COMPARATIVE SAFETY OF SGLT2 AND DPP-4 INHIBITORS ON RISK OF ADVERSE EVENTS IN MIDDLE-AGED ADULTS WITH TYPE 2 DIABETES MELLITUS Parente A , Kim S , Jones B T .
.
.
.