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Douglas L. Leslie, PhD Robert Rosenheck, MD

Changes in Antipsychotic Pharmacotherapy and Healthcare Costs Following a New Diagnosis of Diabetes among Patients with Schizophrenia. Douglas L. Leslie, PhD Robert Rosenheck, MD

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Douglas L. Leslie, PhD Robert Rosenheck, MD

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  1. Changes in Antipsychotic Pharmacotherapy and Healthcare Costs Following a New Diagnosis of Diabetes among Patients with Schizophrenia Douglas L. Leslie, PhD Robert Rosenheck, MD New England Mental Illness Research, Education and Clinical Center (MIRECC);VA Northeast Program Evaluation Center (NEPEC); Yale Medical School

  2. Background • First-generation antipsychotics were introduced in the 1950’s • Second-generation antipsychotics • clozapine, olanzapine, risperidone, quetiapine • At least as effective as first-generation drugs • Have fewer side effects • Associated with weight gain and diabetes • FDA warning

  3. Objectives • To determine risk of new-onset diabetes associated with antipsychotic medications. • To identify the costs associated with treatment of new-onset diabetes. • To determine whether patients switch antipsychotic medications after diagnosis of diabetes.

  4. Sample • Patients with schizophrenia treated in the VA Healthcare System. • No pre-existing diabetes. • “Stable” on an antipsychotic medication. • Followed for up to 2 years between June 1999 and September 2001. • 56,849 patients included in the study.

  5. Methods • Patients with a new diagnosis of diabetes were identified. • Cox proportional hazards model. • A matched control group of patients who did not develop diabetes was identified. • Medication changes and costs were compared.

  6. Study timeline June 1999 September 2001 D Diabetes patient Diabetes onset date Stable period (3 months) D Matched non-diabetes patient Stable period (3 months) Pseudo diabetes onset date

  7. Results • Patients were followed for an average of 15.7 months • 4,132 patients had a new diagnosis of diabetes – annual incidence rate of 4.36% • Unadjusted diabetes risk was highest for clozapine and olanzapine • Total healthcare costs were $3,104 higher for patients with diabetes

  8. Month

  9. Percentage of patients who switch/discontinue antipsychotic medication after diabetes onset

  10. Diabetes risk and costs attributable to second-generation drugs * Based on average cost of $198/month per case of diabetes

  11. Conclusions • Very high rate of diabetes onset in this population (4-5% per year) • Results do not support a “class effect” • Onset of diabetes does not affect antipsychotic pharmacotherapy • Diabetes risk and treatment costs attributable to second-generation drugs are small

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