Improving Value of Publicly Funded Mental Health Care

提高公共资助的精神卫生保健的价值

基本信息

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
项目类别：
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

项目摘要

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）：抗精神病药物是治疗精神分裂症的主要药物，对于治疗 I 型双相情感障碍和难治性重度抑郁症具有重要价值。第二代抗精神病药物 [SGA] 的引入在二十多年前就已深入人心。 1995 年至 2008 年间，美国每年的抗精神病药物治疗就诊人数增加了一倍多，在此期间，抗精神病药物所占的比例SGA 比例从 16% 上升至 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，因为这些付款人为美国大多数精神病患者提供保险。令人惊讶的是，有关其缴费者的信息很少。这种增长——有多少是由于抗精神病药物的过度使用（复方用药、标签外使用）造成的，对支付者的经济影响是什么，或者增长在地理或时间上的变化如何，对于双重合格受益人来说信息特别少。具有复杂需求和高利用率的人群对公共付款人的经济负担可能不仅限于药物的购买成本，尽管有证据表明与某些 SGA 相关的过度代谢风险导致了 FDA 的级别警告并呼吁改进处方实践，被认为具有较高风险的抗精神病药物在治疗患有严重精神疾病的患者中仍然很受欢迎[SMI]，重要的是，我们所知道的主要涉及代谢风险过高的短期健康影响；我们对糖尿病和心血管疾病的影响知之甚少。更长的开发时间或大约我们提出了一项研究计划，该计划使用六个不同地理位置的州参加医疗补助、医疗保险或这两个计划的成年人的纵向（2007 年至 2013 年）医疗补助和医疗保险数据来填写这些关键证据。在目标 1 中，我们评估了过度使用对州和地区抗精神病药物使用和购买成本趋势的影响。在目标 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使用的健康和经济影响。目标 3 我们使用微观模拟模型，结合全国调查、德尔菲收集的专家意见以及医疗补助和医疗保险数据的输入，量化旨在提高 SMI 受益人抗精神病药物治疗价值的策略对 6 年和终生健康和经济的影响。我们采用的数据和方法通过使用当代统计和微观模拟建模方法，通过经验性地结合基于队列的观察、全国调查反应以及德尔菲过程的结果，可以对价值进行多方面的评估。