Impact of Atypical Antipsychotic Use on Health Care Utilization in the Elderly

描述（由申请人提供）：非典型抗精神病药物广泛用于老年人的一系列精神疾病。然而，由于老年患者在药物处置和反应方面的年龄相关变化，他们比成人更容易受到抗精神病药物副作用的影响。研究表明，由于非典型因素，老年人有发生脑血管事件、代谢改变、跌倒和运动障碍的风险。最近的临床试验表明，不良反应限制了非典型药物治疗老年人精神病、攻击性和躁动的有效性。这些安全性和有效性概况将对老年人产生不同的卫生保健后果。然而，对老年患者使用抗精神病药物的卫生保健利用知之甚少。本研究扩展了研究者先前的工作，以评估老年人使用抗精神病药物对健康保健的影响。该研究的具体目的是：(1)描述非典型抗精神病药物在老年人中的使用情况；(2)调查老年人使用典型药物和非典型药物的总体卫生保健使用情况；(3)比较老年人使用奥氮平、利培酮和喹硫平的总体卫生保健使用情况。采用回顾性队列设计，涉及65岁或以上的老年医疗保险和医疗补助（双重合格）患者，拟议的研究将检验以下假设：(i)与使用典型药物的老年人相比，使用非典型药物的老年人的总体医疗保健使用率更高；（ii）非典型抗精神病药物的总体卫生保健使用不同。医疗保健使用将通过住院、门诊、急诊和处方使用等措施进行评估。2001-2003年的医疗保险和医疗补助索赔数据来自四个拥有大量双重合格受益人的州。Heckman选择方法将用于调整Andersen行为模型多变量背景下的选择偏差，以检查老年人与非典型药物相关的医疗保健使用。由于非典型药物的安全性和有效性，该调查将通过解决非典型药物对卫生保健的累积影响，为卫生保健提供者和政策制定者提供有价值的信息。此外，研究结果将有利于优化非典型抗精神病药物的使用和支出在老年人。

DESCRIPTION (provided by applicant): Atypical antipsychotic agents are widely used for a range of psychiatric disorders in the elderly. However, elderly patients are more susceptible to antipsychotic side effects than adults due to their age-related changes in drug disposition and response. Studies have suggested that elderly are at-risk for cerebrovascular events, metabolic alterations, falls, and movement disorders due to atypical agents. The recent clinical trials revealed that adverse effects limit the usefulness of atypical agents for psychosis, aggression, and agitation in the elderly. These safety and efficacy profiles will have diverse health care consequences in the elderly. However, little is known about health care utilization in elderly patients using antipsychotic agents. This study extends the investigators' prior work to evaluate the heath care impact of antipsychotic use in the elderly. Specific aims of the study are: (1) to describe the use of atypical antipsychotic agents in the elderly; (2) to examine the overall health care use among the elderly using typical and atypical agents; and (3) to compare the overall health care use among the elderly using olanzapine, risperidone, and quetiapine. Using a retrospective cohort design involving elderly Medicare and Medicaid (dual eligible) patients 65 years or older, the proposed study will test the hypotheses that: (i) the overall health care use will be higher among the elderly using atypical agents when compared to those using typical agents; and (ii) the overall health care use differs across atypical antipsychotic agents. Health care use will be evaluated using measures such as hospitalization, outpatient visits, emergency visits, and prescription utilization. The 2001-2003 Medicare and Medicaid claims data from four states with high numbers of dual eligible beneficiaries will be used. The Heckman selection method will be used to adjust for the selection bias within the multivariate context of the Andersen Behavioral Model to examine the health care use associated with atypical agents in the elderly. This investigation will provide valuable information to health care providers and policy makers by addressing the cumulative health care impact of atypical agents due to their safety and efficacy profiles. In addition, the findings will be beneficial in optimizing atypical antipsychotic use and expenditures in the elderly. PUBLIC HEALTH RELEVANCE: With increasing evidence of efficacy and safety concerns of atypical agents, there is a need to evaluate atypical antipsychotic use in the elderly. Little is known about the cumulative health care impact of atypical agents due to their safety and efficacy profiles. An evaluation of health care utilization in the elderly will be valuable to health care providers and policy makers to optimize the use and expenditures of atypical antipsychotic agents in this vulnerable population.