title: Diagnoses associated with use of atypical antipsychotics in a commercial health plan: a claims database analysis.
abstract: BACKGROUND
  Atypical antipsychotics are indicated for specific psychiatric conditions; however, they are frequently used for US Food and Drug Administration-nonapproved indications.
  
  
  OBJECTIVE
  This study assessed the types of medical diagnoses associated with atypical antipsychotic prescriptions in commercial health care plans.
  
  
  METHODS
  This retrospective cohort study used the OptumInsight commercial data set from January 2008 to June 2011. The index date was defined as the earliest date of prescription for the atypical antipsychotics aripiprazole, olanzapine, quetiapine, risperidone, and ziprasidone, from January 1, 2009, through June 30, 2010. Medical claims during a 2-year period (12 months before and 12 months after the index date) were used to identify relevant diagnostic codes from the International Classification of Diseases, Ninth Edition, Clinical Modification associated with the antipsychotic prescription. A logistic regression analysis was conducted to examine the predictors of use of atypical antipsychotics without a relevant diagnosis, that is, schizophrenia, bipolar, or major depressive disorder (MDD).
  
  
  RESULTS
  Of 18,352 patients included in the analysis, 3593 (19.5%) who filled a prescription for atypical antipsychotics did not have an approved diagnosis. Off-label utilization varied, with approximately a quarter of patients with prescriptions for quetiapine (24.1%), risperidone (23.1%), or olanzapine (21.8%) being without a relevant diagnostic code, whereas proportions were lower for patients prescribed aripiprazole (14.0%) or ziprasidone (13.1%). Of those with a psychiatric disorder other than schizophrenia, bipolar disorder, or MDD, approximately a third of prescriptions were for anxiety disorders, with similar proportions across all atypical antipsychotics. Patients were often prescribed quetiapine for substance abuse (22.7%), whereas patients with "other psychiatric conditions" were prescribed risperidone (26.3%) or ziprasidone (25.0%). The logistic regression analysis indicated that patients prescribed olanzapine, quetiapine, or risperidone were significantly more likely to have no diagnostic code for schizophrenia, bipolar disorder, or MDD compared with patients prescribed aripiprazole.
  
  
  CONCLUSIONS
  Nearly a fifth of commercially insured patients were prescribed atypical antipsychotics, in particular, olanzapine, quetiapine, or risperidone, for diagnoses that were not aligned with US Food and Drug Administration-approved indications.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, New York. Electronic address: citrome@cnsconsultant.com.
authors.forename: Leslie
authors.initials: L
authors.lastname: Citrome
authors.affiliation: Bristol-Myers Squibb, Plainsboro, New Jersey.
authors.forename: Iftekhar
authors.initials: I
authors.lastname: Kalsekar
authors.affiliation: Bristol-Myers Squibb, Plainsboro, New Jersey.
authors.forename: Zhenchao
authors.initials: Z
authors.lastname: Guo
authors.affiliation: Otsuka America Pharmaceutical, Inc., Princeton, New Jersey.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Laubmeier
authors.affiliation: Bristol-Myers Squibb, Plainsboro, New Jersey.
authors.forename: Tony
authors.initials: T
authors.lastname: Hebden
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000191:economics / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy; D016208:Databases, Factual; D003865:Major Depressive Disorder / Q000188:drug therapy; D011307:Drug Prescriptions / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007345:Insurance Claim Review; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy*; D008875:Middle Aged; D056687:Off-Label Use / Q000191:economics; D012189:Retrospective Studies; D012559:Schizophrenia / Q000188:drug therapy; D014481:United States; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents
keywords: atypical antipsychotic; medical claims; off-label; prescription