OBJECTIVE: Lurasidone was approved for the treatment of bipolar depression in June 2013. This analysis compared pre-index comorbidities, healthcare utilization, and costs among patients initiating lurasidone or other atypical antipsychotics (quetiapine, aripripazole, risperidone, olanzapine, and ziprasidone).
METHODS: Claims data analysis of bipolar disorder patients (≥18 years) initiating atypical antipsychotics from 6/28/2013-11/30/2013 in the Optum database was conducted. Eligible patients had to be continuously enrolled ≥6 months pre-index and ≥3 months post-index atypical antipsychotic initiation. Cardiometabolic comorbidities, mental health and all-cause resource utilization, and costs were compared between lurasidone and other antipsychotic cohorts.
RESULTS: Of the 3,441 patients, 65.2% were female; 13.1% received lurasidone, 30.4% quetiapine, 25.4% aripiprazole, 13.0% risperidone, 9.0% olanzapine, 5.4% ziprasidone, 3.7% other. Mean age (38.9±13.4 years) and hypertension prevalence (20.0%) was similar among all antipsychotic cohorts. At baseline, lurasidone initiators had significantly higher rates of diabetes (13.1% versus 8.3%) and hyperlipidemia (23.3% versus 16.4%) than quetiapine. Baseline mental health resource utilization (mean number of office visits: 9.0 versus 5.3-6.4; psychiatrist visits: 3.9 versus 1.9-2.5) and healthcare costs ($875 versus $472-$597, and $1,407 versus $453-$821 for mean office visits costs and pharmacy costs, respectively) were also significantly higher among lurasidone initiators than all other cohorts; similar findings were reported in all-cause utilization and costs.
CONCLUSIONS: This analysis suggests that bipolar disorder patients initiating lurasidone may have greater symptom severity and higher prevalence of cardiometabolic risk factors at pre-index versus other atypical agents. Assessment of the comparative effectiveness of atypical agents in patients with bipolar disorder is needed.