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Abstract
Objective:
To assess the association between pre-existing metabolic syndrome and health outcomes among veterans with schizophrenia.
Methods:
The Veterans Integrated Service Network 16 data (VISN16) for 10/2002 – 08/2005 were used to identify patients (n = 593) with schizophrenia (ICD-9 codes: 250.xx) who were switched to a new antipsychotic agent in response to metabolic monitoring as part of a VISN 16 metabolic monitoring program. Two groups (patients with pre-existing metabolic syndrome [MetSyn+] and without [MetSyn−]) were compared on resource utilization, antipsychotic adherence (medication possession ratio: MPR) and persistence (time to all-cause discontinuation of the switched antipsychotic) over 1 year.
Results:
About one-third of the patients who have undergone metabolic monitoring before the medication switch (35.2%) had metabolic syndrome. The two groups did not significantly differ on healthcare resource utilization, MPR, or time to all-cause medication discontinuation. Adherence and persistence levels were relatively poor for both groups (mean MPR = 0.33 for MetSyn+; MPR = 0.38 for MetSyn−). The median time to all-cause medication discontinuation was 50 days for both groups.
Conclusions:
In this retrospective study of patients with schizophrenia, the presence of pre-existing metabolic syndrome did not appear to impact patients’ healthcare resource utilization or their adherence and persistence with antipsychotic medication.
Transparency
Declaration of funding
This study was supported by Eli Lilly and Company.
Declaration of financial/other relationships
L.S., Y.-J.C and Y.Z. have disclosed that they are affiliated with the Department of Health Systems Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA. L.S. and Y.Z. have also disclosed that they are WOC employees/investigators for the Southeast Louisiana Veterans Health Care System. L.S. has disclosed that, at the project initiation, he was a WOC employee/investigator for the Little Rock Veterans Health Care System. V.F. and D.W. have disclosed that they are affiliated with the School of Medicine at Tulane University. H.A.-S. has disclosed that he is a full-time employee and minor shareholder of Lilly.
Some peer reviewers receive honoraria from CMRO for their review work. The peer reviewers of this paper have disclosed that they have no relevant financial relationships.
Acknowledgements
The authors have disclosed that they had no outside editorial assistance in preparing this manuscript. They thank the VISN 16 data warehouse for the de-identified dataset.
The contents of this manuscript do not represent the views of the Department of Veterans Affairs or the US Government.
L.S. was the principal investigator for the study (conceptualization, study design, analytical plan, SAS programming guidance, interpretation of the results, and manuscript preparation). H.A.–S. conceived of the study, participated in its design, participated in the analytical plan, participated in the interpretation of the results and helped draft the manuscript. Y.-J.C. performed the statistical analyses, participated in the design of the study, participated in the analytical plan and participated in the interpretation of the results. Y.Z. performed the additional statistical analyses and the interpretation of the results. V.F. and D.W. participated in the design of the study, the analytical plan, participated in the interpretation of the results and assisted in drafting the manuscript.