title: The rate, pattern, and cost of use of antiparkinsonian agents among patients treated for schizophrenia in a managed care setting.
abstract: OBJECTIVE
  To examine the use and economic cost of antiparkinsonian agents during the medication management of patients diagnosed with schizophrenic disorders in a naturalistic healthcare setting.
  
  
  METHODS
  Cross-sectional retrospective analysis of 1-year (1999) administrative data from a large managed care organization.
  
  
  METHODS
  Patients were 1938 adults who were treated for a schizophrenic disorder. Monthly per patient utilization rate and cost of antiparkinsonian agents, and the proportion of the total psychiatric medication costs attributed to the antiparkinsonian agents, were compared across antipsychotic medications (typical, atypical, olanzapine, risperidone), age, sex, and diagnostic subtype.
  
  
  RESULTS
  About one third (39%) of the patients were treated with typical antipsychotics only, and half of them (51%) received antiparkinsonian agents. Those treated with atypical antipsychotics only (41%) were considerably less likely to receive antiparkinsonian agents (25%), and the rate of use differed by atypical type such that risperidone-treated patients were more likely to receive antiparkinsonian agents than those treated with olanzapine. Lower utilization rates of antiparkinsonian agents were also found among patients age 75 years or older, and among those diagnosed with a schizoaffective disorder. Average monthly per patient cost of antiparkinsonian agents was 3.0 dollars, constituting 2.6% of the monthly expenditure on all psychiatric medications.
  
  
  CONCLUSIONS
  Adjunctive use of antiparkinsonian agents differs widely among patients who are treated with typical or atypical antipsychotic drugs, and differs between types of atypical antipsychotics. The choice of atypical antipsychotics that have a lower liability for extrapyramidal symptoms may assist in optimizing the long-term functional outcomes of schizophrenia patients.
authors.affiliation: Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Ind 46285, USA. haya@lilly.com
authors.forename: Haya
authors.initials: H
authors.lastname: Ascher-Svanum
authors.forename: John S
authors.initials: JS
authors.lastname: Kennedy
authors.forename: David
authors.initials: D
authors.lastname: Lee
authors.forename: Merle
authors.initials: M
authors.lastname: Haberman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000191:economics* / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000145:classification / Q000191:economics / Q000627:therapeutic use; D016527:Drug Costs; D017723:Drug Utilization Review; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000191:economics*; D008875:Middle Aged; D012559:Schizophrenia / Q000188:drug therapy*; D014481:United States
chemical_list: D000978:Antiparkinson Agents; D014150:Antipsychotic Agents