Clinical and economic outcomes associated with @entity1037 for the treatment of XXXX in a county mental health population.

@entity1 @entity1037 @entity716
BACKGROUND: The comparatively high acquisition costs of the newer antipsychotic medications have caused the mental health community to look closely at their potential benefits. OBJECTIVE: The purpose of this study was to perform a naturalistic analysis of changes in mental health service utilization, economic costs, and clinical outcomes after the initiation of @entity1037 therapy for @entity716 in an indigent @entity1 population from a large county-operated mental health care system. METHODS: This was a prospective, uncontrolled investigation using a mirror-image cohort design. All captured costs from @entity1 who began @entity1037 therapy between November 1, 1996, and April 30, 1998, were analyzed in an intent-to-treat fashion to compare resource utilization in the 12 months immediately before and after the intervention. Clinical function was assessed at baseline and 6 months using the Positive and Negative Syndrome Scale (PANSS). In a subgroup analysis, the baseline characteristics of @entity1 who completed 12 months of @entity1037 treatment were compared with those of @entity1 who (1) changed medication or (2) changed pay or source or were lost to follow-up. RESULTS: One hundred eighty-nine @entity1 were started on @entity1037 treatment during the 18-month study entry phase. @entity1 were primarily male (63.5%) and had a mean age of 35.9 years. Most (66.3%) had a formal diagnosis of thought disorder. Fifty-six @entity1 received @entity1037 for 12 consecutive months, and 22 were switched to other psychotropic medications. Of the remaining 111 @entity1 , 70 changed payors (ie, qualified for Medicaid), and 41 were lost to follow-up. In the subgroup analysis, @entity1 who completed 12 months of treatment (ie, responders) had significantly lower mean PANSS total scores at baseline compared with those who changed payors or were lost to follow-up (P = 0.047), and were significantly more likely to have a formal diagnosis of thought disorder (P = 0.039). Responders demonstrated a significant reduction in PANSS total and negative subscale scores at 6-month follow-up (both measures, P < 0.001). In the intent-to-treat analysis of resource utilization in all @entity1 with complete data sets (n = 78), hospitalization costs and crisis costs decreased significantly during the 12-month follow-up period (P = 0.003 and P = 0.009, respectively), and both outpatient and medication costs increased significantly (P = 0.035 and P < 0.001, respectively). Overall, the change in total annual resource utilization during the 12 months after initiation of @entity1037 was not statistically significant (mean decrease per @entity1 ,  1,991; 95% CI, - 5,258 to  1,122). CONCLUSIONS: Initiation of @entity1037 therapy was associated with favorable clinical outcomes in this population, particularly in @entity1 with a formal diagnosis of thought disorder. Overall, there was a cost shift away from hospital and crisis costs toward medication and outpatient services costs. The decline in total resource utilization was not statistically significant, although it may be of practical importance.
