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: 9275022
• 负责人: Marcela V Horvitz-Lennon
• 金额: $ 61.63万
• 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/9275022
• 关键词: Adopted; Adoption; Adult; Antipsychotic Agents; Bipolar Disorder; 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; Geography; Goals; Government Financing; Growth; Health; Healthcare; Hypertension; Illinois; Individual; Intervention; Label; Louisiana; Major Depressive Disorder; Medicaid; Medicare; 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; Structural Models; Surveys; System; Testing; Thinness; Time; Treatment Cost; Twin Multiple Birth; Ursidae Family; Visit; alternative treatment; base; beneficiary; cohort; cost; dual eligible; 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（由适用提供）：抗精神病药是精神分裂症治疗的主要手段，在治疗双相情感障碍和耐治疗的主要抑郁症中很有价值。在二十年前，在1995年至2008年之间，第二代抗精神病药[SGA]引入了二十年前的心理卫生保健，在这一时期，SGA的份额从16％升至93％。 Medicaid和Medicare承担了与SGA利用率增长相关的经济负担的很大一部分，因为这些付款人为美国大多数精神病患者提供了有关这种增长的贡献者的信息，这是由于过度使用抗精神病药物所致的贡献者，这是由于过度使用的抗精神病药物（多物种，非列赛）对付款者的经济意义，或者对付款者的经济意义，或者是付费者，或者是临时的。对于双重合格的受益人，有复杂需求和高利用率的人群，信息特别薄。对公共付款人的经济燃烧可能不仅限于毒品的购买费用。尽管与某些SGA相关的代谢风险过多的证据导致了FDA班级警告并呼吁改善处方实践，但被确定为具有较高风险的抗精神病药在治疗严重精神疾病的人中仍然很受欢迎[SMI]。重要的是，我们所知道的很大程度上涉及过度代谢风险的短期健康影响；我们对与这种风险相关的公共付款人需要更长的时间或经济燃烧需要更长的时间来了解糖尿病和心血管疾病。我们提出了一项研究计划，该计划使用纵向（2007-2013）的Medicaid和Medicare数据，用于在六个地理位置多样的州中入学的成年人或两个计划，以填补这些关键的证据差距。在AIM 1中，我们评估了过度使用对抗精神病药物利用和购买成本的州和区域趋势的贡献。在AIM 2中，我们使用边际结构模型来量化SMI受益人累积纵向抗精神病药物的健康和经济影响。 AIM 3我们使用微仿真模型以及全国调查，Delphi聚集的专家意见以及Medicaid和Medicare数据的投入来量化旨在增强SMI受益人抗精神病药物价值的6年和终身健康和经济影响。我们采用的数据和方法允许通过经验相结合的基于队列的观察结果，国家调查的反应以及使用当代统计和微仿真模型方法来对价值进行多方案的评估。