221036 Alternative and “off-label” uses of antipsychotic medications in Medicaid

Tuesday, November 9, 2010

Michael T. Abrams, MPH , Acute care and Policy Research Division, The HIlltop Institute, University of Maryland, Baltimore County, Baltimore, MD
Jessica R. Kopelke, BS , Acute care and Policy Research Division, The HIlltop Institute, University of Maryland, Baltimore County, Baltimore, MD
Osama O. Elfaki, MS, MIA , Information Systems and Programming Division, The HIlltop Institute, University of Maryland, Baltimore County, Baltimore, MD
Susan Chen, MBA , Information Systems and Programming Division, The HIlltop Institute, University of Maryland, Baltimore County, Baltimore
David S. Salkever, PhD , Department of Public Policy, University of Maryland, Baltimore County, Baltimore, MD
Despite the terminology, antipsychotics are used for disorders other than psychosis, especially severe mood disorders, and including non-FDA approved indications. This work used Medicaid administrative data from a single state and year (7/2000 to 6/2001) to estimate rates of alternative uses for antipsychotics. This year is the baseline for a four year longitudinal follow-up of antipsychotic effectiveness. An indicator of alternative antipsychotic use will be used to create covariates of drug choice for that study. Here we report on alternative use by mental health diagnoses. All unique Medicaid clients with at least one antipsychotic prescription and no record of schizophrenia (n=16,337) were considered. A subset (n=4,237) of those treated by ‘experience providers'- defined as a providers treating at least 20 patients with schizophrenia in the year- were also considered. For the complete sample, diagnoses observed in over 5% of the population were: episodic mood (35%), dementia (16%), depression, nos (16%), anxiety, dissociative and somatoform (14%), persistent mental disorders due to other conditions (11%), other non-organic psychoses (9%), and mental retardation (8%). For clients treated by the ‘experienced providers', these rates were comparable, but intensified toward mood disorders: 69%, 10%, 28%, 24%, 8%, 15%, and 10%, respectively. Among the clients having contact with ‘experienced providers' the following other diagnoses were also prevalent across their Medicaid records: conduct disorder, nos (9%) and adjustment reaction (8%). These results are consistent with substantial alternative use of antipsychotics especially for mood disorders. They also suggest distinctive patterns for the most experienced mental health care providers.

Learning Areas:
Chronic disease management and prevention
Clinical medicine applied in public health
Provision of health care to the public

Learning Objectives:
1. Explain how Medicaid administrative data can be used to discern patterns regarding antipsychotic medication use. 2. Describe to what extent antipsychotics were used to treat indications other than schizophrenia in the period July 2000 to June 2001. 3. Assess which indications (on or off-label) are connected to alternative uses of antipsychotics in a Medicaid population, and consider correlates to those uses.

Keywords: Mental Disorders, Treatment Patterns

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Presentation will discusses the extent to which antipsychotics are used for indications other schizophrenia. No specific alternative therapies will be promoted or specifically discussed regarding comparative effectiveness.

Qualified on the content I am responsible for because: I am qualified to present this work as an MPH graduate, a public policy PhD student (presently working on my dissertation), and as the person who directly supervised or carried out all the analyses related to this work.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
Maryland's Department of Health and Mental Hygiene Mental health and substance abuse policy analysis Consultant

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.