title: The effect of institutional fiscal stress on the use of atypical antipsychotic medications in the treatment of schizophrenia.
abstract: This paper examines the effects of medical center budget stress on the use of expensive atypical antipsychotic medications for the treatment of schizophrenia in the Department of Veterans Affairs (VA). VA prescription drug records were collected for patients diagnosed with schizophrenia. Generalized estimation equations were used to identify patient and facility characteristics (especially fiscal stress) that are associated with the use of atypical antipsychotics. Of the 34,925 patients in the final sample, over half received an atypical antipsychotic, usually either olanzapine or risperidone. Unexpectedly, increased fiscal stress was associated with increased likelihood of receiving atypical antipsychotics. Among patients who receive atypicals, however, fiscal stress was associated with reduced likelihood of receiving the more expensive atypicals (clozapine and olanzapine) but positively associated with receiving the least expensive atypical (risperidone). Institutional fiscal pressure does not seem to reduce the broad availability of these medications overall but does affect which drug is prescribed.
authors: VA Connecticut Mental Illness Research, Education and Clinical Center, West Haven, USA.
authors: D L
authors: DL
authors: Leslie
authors: R
authors: R
authors: Rosenheck
mesh_terms: D000544:Alzheimer Disease / Q000188:drug therapy / Q000453:epidemiology; D014150:Antipsychotic Agents / Q000191:economics / Q000627:therapeutic use*; D001569:Benzodiazepines; D002017:Budgets / Q000706:statistics & numerical data; D003024:Clozapine / Q000191:economics / Q000627:therapeutic use; D015897:Comorbidity; D003866:Depressive Disorder / Q000188:drug therapy / Q000453:epidemiology; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006268:Health Facilities / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077152:Olanzapine; D010890:Pirenzepine / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data; D012044:Regression Analysis; D018967:Risperidone / Q000191:economics / Q000627:therapeutic use; D012559:Schizophrenia / Q000188:drug therapy* / Q000453:epidemiology; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs / Q000191:economics
chemical_list: D014150:Antipsychotic Agents; D001569:Benzodiazepines; D010890:Pirenzepine; D003024:Clozapine; D018967:Risperidone; D000077152:Olanzapine