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The Antipsychotic Atlas Project - Overview Kennedy, J (PI); S Murphy; S McPherson & M Layton (co-Is) Start date: 9/13 End date: 8/15 This research project is intended to benefit Washington residents with dementia, schizophrenia, bipolar disorder or diabetes and is funded by a $340,288 grant awarded from the Washington State Attorney General’s Office. The grant originated as part of a “cy pres,” or “next best use” of settlement monies, stemming from a 2012 settlement agreement between the Washington State Attorney General’s Office and Janssen Pharmaceuticals, Inc., concerning the marketing of Risperdal, Risperdal Consta, Risperdal M-Tab and Invega. The Antipsychotic Atlas Project – Background • The top five atypical antipsychotics account for over $8 billion in annual U.S. sales, paid mostly by the federal Medicare and Medicaid programs. • These antipsychotic medications are approved by the Federal Drug Administration (FDA) for treatment of schizophrenia and bipolar disorder, but are also prescribed to millions of Americans with other psychiatric conditions. • Information on the current scope of off-label prescribing and other clinically important antipsychotic use patterns is quite limited. The Antipsychotic Atlas Project – Study Objectives • The objective of this two year study is to provide a detailed portrait of antipsychotic utilization in Washington at the regional support network (RSN) and county level. • We will use newly released Medicare D claims data to document patient level disparities in use, including off label use and nonadherence. • We will then assess relative rates of metabolic syndrome, stroke, and thromboembolism among WA antipsychotic users. Descriptive analysis of antipsychotic users Numerator file 1+ antipsychotic prescriptions N = 29,973 Denominator file All 2010 WA Part D Beneficiaries (includes Medicare Advantage) N = 477,310 6.3% of WA Part D recipients filled an antipsychotic prescription in 2010 Antipsychotic prescription use by WA county Anti-Psychotic Use by County County Pierce Columbia Kitsap Whitman Thurston King Spokane Whatcom Walla Walla Snohomish Cowlitz Grays Harbor Chelan Benton Clark Skagit Lewis Yakima Douglas Franklin N 4,007 40 1,091 178 1,198 8,215 2,664 1,049 296 2,707 619 426 290 565 1,879 548 439 947 230 172 Percent 8.3% 8.2% 8.1% 8.0% 7.8% 6.9% 6.8% 6.4% 6.1% 6.1% 5.7% 5.6% 5.5% 5.5% 5.4% 5.2% 5.2% 5.0% 4.8% 4.8% County Clallam Asotin Pacific Grant Jefferson Mason Kittitas Skamania Island Okanogan San Juan Klickitat Stevens Ferry Adams Garfield Pend Oreille Wahkiakum Lincoln N 448 120 125 315 169 223 115 28 238 164 65 84 149 26 31 11 43 16 39 Percent 4.8% 4.7% 4.5% 4.5% 4.4% 4.3% 4.3% 4.0% 3.9% 3.8% 3.6% 3.6% 3.6% 3.5% 3.4% 3.3% 3.1% 3.0% 2.9% Antipsychotics Used in 2010 and 2011 Category Typical antipsychotics Haloperidol Perphenazine Fluphenazine Thiothixene Chlorpromazine Loxapine Thioridazine Trifluoperazine Atypical antipsychotics Quetiapine Risperidone Aripiprazole Clozapine Ziprasidone Paliperidone Olanzapine N 76,790 35,019 11,851 9,288 5,816 5,329 3,319 3,309 2,848 587,885 229,000 172,018 77,165 49,456 46,029 11,242 2,975 percent 11.6% 45.6% 15.4% 12.1% 7.6% 6.9% 4.3% 4.3% 3.7% 88.4% 39.0% 29.3% 13.1% 8.4% 7.8% 1.9% 0.5% WA Antipsychotic User Attributes Category Gender Women Men Race and ethnicity White Black Asian Hispanic Native American Age 21-64 65 or older Dual eligibility Dual eligible Medicare only N percent 17,355 12,617 6.3% 6.3% 25,465 1,586 1,057 1,062 462 6.2% 12.8% 4.2% 6.5% 8.8% 17,659 12,313 19.1% 3.2% 21,959 8,388 15.7% 2.5% The Antipsychotic Atlas Project – What’s Next? Patterns of prescription drug events or PDEs (N=2.4 million) 1. Antipsychotic medication discontinuation a) Without replacement (nonadherence) b) With replacement (switching) 2. Excessive or subtherapeutic dosing 3. Simultaneous use of psychiatric medications (polypharmacy) The Antipsychotic Atlas Project – What’s Next? Analysis of inpatient and outpatient services (fee for service beneficiaries; N=1.3 million claims) 1. Off-label prescribing rates (by drug, county and recipient attributes) 2. Adverse clinical outcomes (metabolic syndrome, stroke, thromboembolism)