Heterogeneity and Econometric Net Cost Estimates of Schizophrenia Drug Treatments

描述（由申请人提供）：由于精神分裂症患者抗精神病药物支出的快速增长，这些支出的经济理由已成为一个主要的精神卫生政策问题，特别是医疗补助计划，该计划为80%的支出提供资金。最近的计量经济学研究提供了选择非典型（较新的）而不是典型（传统的，第一代）抗精神病药物对精神分裂症总治疗成本的净影响的总体点估计。虽然这些研究没有对不同的患者群体进行估计，但其结果的某些特征表明，患者和特定药物之间的净成本影响存在相当大的异质性。这种异质性是NIMH研究重点强调的一个问题，该研究重点是为个性化的精神卫生保健开发知识库；异质性也是阐明与使用特定抗精神病药物有关的医疗补助政策和护理指南的一个特别关注的问题，因为这些政策和指南应该适用于具有不同治疗史和病程的所有类型的患者。进一步的研究探索这种异质性是可取的，并且是可行的，因为医疗补助索赔数据库的规模和时间跨度非常大。本研究将发展不同的抗精神病药物选择的成本影响的信息，这些抗精神病药物是根据治疗过程和病史分类的特定患者群体。来自1995-2005年马里兰医疗补助计划的数据将是这项研究的主要数据库。根据治疗过程和病史对患者进行分组的标准将由具有临床、政策和指南制定问题经验的项目咨询委员会制定。对于每个患者组，将获得成本影响估计，并评估估计对估计方法选择的敏感性（普通最小二乘法与替代工具变量与倾向评分加权）。将对总成本的主要成本和利用部分进行类似的影响估计；这些估计将使我们能够更好地了解对总治疗费用产生净正面或负面影响的因素。由于许多患有精神分裂症的医疗补助受益人也被医疗保险覆盖，我们将对双重资格的抗精神病药物选择进行类似的总成本影响评估（包括医疗保险成本）。我们将把这些估计值与单独基于医疗补助索赔数据的相应估计值进行比较。为此目的，2002-2005年马里兰双重资格的医疗保险和医疗补助索赔数据将被使用。研究结果将提交出版，并报告给管理马里兰州医疗补助计划的机构（州医疗补助机构和精神卫生管理局）。审查说明：本申请作为R03小额赠款提交，以响应PA-06-180；内容在“心理健康经济学研究”（NIMH PA-07-213）的范围内。

DESCRIPTION (provided by applicant): Due to a rapid rise in spending on antipsychotic drugs for patients with schizophrenia, the economic rationale for these expenditures has become a major mental health policy concern, particularly for Medicaid programs that fund 80% of this spending. Recent econometric studies have provided overall point estimates of the net impact of choosing atypical (newer) rather than typical (conventional, first-generation) antipsychotics on the total treatment cost of schizophrenia. While these studies did not develop estimates for different groups of patients, selected features of their results point to considerable heterogeneity in net cost impacts among patients and among specific drugs. This heterogeneity is an issue highlighted by the NIMH research focus on developing a knowledge base for personalized mental health care; heterogeneity is also a particular concern for articulating Medicaid policies and care guidelines relating to the use of specific antipsychotics, since these policies and guidelines should be adaptable to all types of patients, with varying treatment histories and illness courses. Further research that explores this heterogeneity is desirable, and is feasible because of the very large size and time span of Medicaid claims databases. This study will develop information on the varying cost impacts of choices among antipsychotics that are specific to groups of patients classified by treatment course and history. Data from the Maryland Medicaid program for 1995-2005 will be the principal database for the study. Criteria for classifying patients into groups, defined by treatment course and history, will be developed by a project advisory board with experience in clinical, policy, and guidelines development issues. For each of the patient groups, cost impact estimates will be obtained, and the estimates' sensitivity to choice of estimation method (ordinary least squares vs. instrumental variables with alternative instruments vs. propensity score weighting) will be assessed. Analogous impact estimates will be obtained for major cost and utilization components of total costs; these estimates will allow us to better understand the factors that produce net positive or negative impacts on total treatment costs. Since many Medicaid beneficiaries with schizophrenia are also covered by Medicare, we will develop analogous total cost impact estimates (including Medicare costs) of antipsychotic choices for dual eligibles. We will compare these estimates with the corresponding estimates based on Medicaid claims data alone. For this purpose, Medicare and Medicaid claims data for 2002-2005 for Maryland dual eligibles will be used. Study results will be submitted for publication, and reported to the agencies that manage Maryland's Medicaid program (the state Medicaid authority, and the Mental Hygiene Administration). Review note: This application is submitted as an R03 small grant in response to PA-06-180; the content is within the scope of "Research in Mental Health Economics" (NIMH PA-07-213).