Improving Value of Publicly Funded Mental Health Care

提高公共资助的精神卫生保健的价值

• 批准号: 9027083
• 负责人: Marcela V Horvitz-Lennon
• 金额: $ 62.08万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-06-01 至 2020-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9027083
• 关键词: Accounting; Adopted; Adoption; Adult; Antipsychotic Agents; Bipolar I; California; Cardiovascular Diseases; Cardiovascular system; Caring; Chlorpromazine; Clozapine; Complement; Complex; Costs and Benefits; Data; Data Sources; Diabetes Mellitus; Disease; Drug usage; Dyslipidemias; Economic Burden; Economics; Enrollment; Expert Opinion; Exposure to; FDA approved; Funding; Generations; Goals; Growth; Health; Healthcare; Hypertension; Illinois; Individual; Intervention; Label; Louisiana; Major Depressive Disorder; Marketing; Medicaid; Medicare/Medicaid; Mental Health; Mentally Ill Persons; Metabolic; Methodology; Missouri; Modeling; Morbidity - disease rate; New York; Non-Insulin-Dependent Diabetes Mellitus; North Carolina; Output; Patient risk; Patients; Pharmaceutical Preparations; Polypharmacy; Population; Prevention; Process; Research; Resistance; Risk; Rosa; Safety; Schizophrenia; Staging; Structural Models; Surveys; System; Testing; Time; Treatment Cost; Twin Multiple Birth; Ursidae Family; Visit; alternative treatment; base; beneficiary; cohort; cost; economic impact; economic implication; economic outcome; health economics; high risk; improved; outcome forecast; pressure; programs; public health relevance; response; severe mental illness; standard of care; tool; trend

 DESCRIPTION (provided by applicant): Antipsychotic drugs are the mainstay of the treatment of schizophrenia and are valuable in the treatment of bipolar I disorder and treatment-resistant major depressive disorder. The introduction of second-generation antipsychotics [SGAs] over two decades ago profoundly changed mental health care in the U.S. Annual antipsychotic treatment visits more than doubled between 1995 and 2008, a period during which the share of antipsychotics that was SGA rose from 16% to 93%. Medicaid and Medicare bear a large portion of the economic burden associated with the growth in SGA utilization because these payers provide coverage to the majority of mentally ill people in the U.S. Surprisingly little information exists on contributors to this growth - how much is due to antipsychotic overuse (polypharmacy, off-label use), what are the economic implications to payers, or how growth varies geographically or temporally. Information is particularly thin for dually eligible beneficiaries, a population with complex needs and high utilization. The economic burden to public payers may not be limited to the drugs' purchasing costs. Although evidence on the excess metabolic risk associated with some SGAs led to a FDA class warning and calls for improved prescribing practices, antipsychotics identified to have higher risk remain popular in the treatment of people with serious mental illness [SMI]. Importantly, what we do know largely pertains to short-term health impacts of excess metabolic risk; we know little about diabetes and cardiovascular disease that take longer time to develop or about the economic burden to public payers associated with this risk. We propose a program of research that uses longitudinal (2007- 2013) Medicaid and Medicare data for adults enrolled in Medicaid, Medicare, or both programs in six geographically diverse states to fill in these critical evidence gaps. In Aim 1 we assess the contribution of overuse to state and regional trends in antipsychotic utilization and purchasing costs. In Aim 2 we use marginal structural models to quantify the health and economic impacts of cumulative longitudinal antipsychotic utilization in beneficiaries with SMI. In Aim 3 we use microsimulation modeling with inputs from a national survey, Delphi-gathered expert opinion, and Medicaid and Medicare data to quantify the 6-year and lifetime health and economic impacts of strategies aimed at enhancing value of antipsychotic treatment in beneficiaries with SMI. The data and the methodology we adopt permit a multi-faceted assessment of value by empirically combining cohort-based observations, national survey responses, and results from a Delphi process using contemporary statistical and microsimulation modeling approaches.

 描述（由申请人提供）：抗精神病药物是精神分裂症治疗的主要药物，在双相I型障碍和难治性重度抑郁症的治疗中有价值。二十多年前，第二代抗精神病药物（SGA）的引入深刻地改变了美国的精神卫生保健，1995年至2008年期间，每年的抗精神病药物治疗次数增加了一倍多，在此期间，SGA的抗精神病药物比例从16%上升到93%。医疗补助和医疗保险承担了与SGA使用率增长相关的大部分经济负担，因为这些支付者为美国大多数精神病患者提供了保险。令人惊讶的是，关于这种增长的贡献者的信息很少-有多少是由于抗精神病药物过度使用（多药，标签外使用），对支付者的经济影响是什么，或者增长在地理上或时间上如何变化。对于具有双重资格的受益人来说，信息尤其薄弱，因为他们的需求复杂，利用率很高。公共支付者的经济负担可能不仅限于药品的购买成本。尽管与一些SGAs相关的过度代谢风险的证据导致FDA警告并呼吁改善处方实践，但确定具有较高风险的抗精神病药物在治疗严重精神疾病患者中仍然很受欢迎[SMI]。重要的是，我们所知道的主要是过度代谢风险对短期健康的影响;我们对糖尿病和心血管疾病的发展需要更长的时间，或者与这种风险相关的公共支付者的经济负担知之甚少。我们提出了一项研究计划，使用纵向（2007- 2013）医疗补助和医疗保险数据的成年人参加医疗补助，医疗保险，或在六个地理位置不同的国家，以填补这些关键的证据差距。在目标1中，我们评估了过度使用抗精神病药物的使用和购买成本对州和地区趋势的贡献。在目标2中，我们使用边际结构模型来量化重度精神障碍受益人累积纵向抗精神病药物使用对健康和经济的影响。在 目标3：我们使用微观模拟建模，输入来自全国调查，德尔菲收集的专家意见，医疗补助和医疗保险数据，以量化6年和终身健康和经济影响的战略，旨在提高抗精神病药物治疗的价值受益人与SMI。我们采用的数据和方法允许多方面的价值评估经验结合队列为基础的观察，国家调查的反应，并从德尔菲过程中使用当代统计和微观模拟建模方法的结果。