Journal of Health & Medical Economics

Adherence to Lurasidone and other Atypical Antipsychotics among Patients with Bipolar Disorder: A Real World Assessment

Context: Nonadherence to atypical antipsychotics is pervasive and contributes to suboptimal outcomes in patients with bipolar disorder.
Objective: Treatment adherence and discontinuation rates of lurasidone and other atypical antipsychotics of Medicaid and commercially-insured patients with bipolar disorder were evaluated.
Design: Patients newly initiating atypical antipsychotic therapy for bipolar disorder were identified in the Truven Health’s MarketScan® Commercial Claims and Encounters (Commercial) and the MarketScan® Medicaid Multi-State (Medicaid) databases.
Patients: Patients were grouped into eight treatment cohorts based on the first agent filled between October 1, 2009 and March 31, 2012.
Main Outcome Measures: Adherence was measured by medication possession ratio (MPR), discontinuation rate, and mean time to discontinuation during a 6-month follow-up. Medicaid and commercial data were analyzed separately.
Results: Among commercially-insured patients, the mean (SD) MPR was significantly higher in the lurasidone cohort compared to the olanzapine cohort [0.512 (0.335) vs. 0.445 (0.320); p < 0.05]. Lurasidone patients were less likely to discontinue than olanzapine patients (61.4% vs. 70.5%; p < 0.05). Among Medicaid patients, the mean MPR for lurasidone (0.535) was significantly higher than among those treated with other atypical antipsychotics (0.418 - 0.461) (all p < 0.05). The percentage of lurasidone users discontinuing index therapy was significantly lower than those in all other cohorts except quetiapine XR (all p < 0.05). In both commercial and Medicaid populations, time to index therapy discontinuation did not differ significantly between treatment cohorts.
Conclusion: Commercially-insured bipolar patients initiating lurasidone had better adherence and lower discontinuation rates versus olanzapine. Among the Medicaid bipolar population, patients initiating lurasidone exhibited better adherence and lower discontinuation rates compared to patients initiating other atypical antipsychotics.

Author(s):

Rajagopalan K, Wade SW, Chu Bong-Chul, Loebel A

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