Antipsychotic drug utilization patterns and treatment -emergent diabetes: A methodological comparison of incidence using a claims database
Year: 2006
Type: dissertation
Study design: Observational Study
Abstract: The study purposes were to: 1) examine antipsychotic utilization trends; and 2) \nevaluate relationships between antipsychotic utilization and treatment-emergent \ndiabetes when methodologies varied while controlling for covariates. \nClaims databases from North and South Texas Veterans Administration \n(1993-2004) were used to identify adults newly initiated on antipsychotics. For \nPurpose 2, only patients with no previous diabetes were eligible. Seven models were \ncreated based on the following methodological variations: 1) study designs \n(retrospective cohort and case-control); 2) treatment exposure assignment (intent-totreat \n(ITT) and as-treated (AT)); and 3) statistical approaches (propensity scoring, \nstandard and conditional logistic regression, and Cox proportional hazards function). \nCovariates included: demographics, general health comorbidities, mental health \ncomorbidities, drug utilization patterns, treatment duration, medication re-exposure, \nand treatment initiation year. \nRegarding Purpose 1, from 1997-2003, antipsychotic utilization shifted from \nfirst to second generation, with olanzapine and risperidone most frequently prescribed. \nMonotherapy was the predominant utilization pattern with switching and combination \ntherapy used infrequently. Of the eligible patients (N=8,949) for Purpose 2, \nregardless of variations in methodologies of the seven tested models (eight models \nwere proposed), there were no significant differences in diabetes risk among patients \nwho were: 1) initiated on SGAs compared to those on FGAs; 2) initiated on \nolanzapine compared to those on risperidone; and 3) exposed to olanzapine or \nquetiapine compared to those exposed to FGAs. Inconsistent results among the seven \nmodels were observed when comparisons were made between: 1) patients initiated on \nquetiapine compared to those on risperidone; and 2) patients exposed to risperidone \ncompared to those exposed to FGAs. Differences occurred among the following \nmethods: ITT retrospective cohort and ITT case-control; and AT retrospective cohort \nand AT case-control. \nWith respect to antipsychotic utilization, results of the various models using \ndifferent methodologies were largely consistent.
Author: Min Yang
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2299974866