title: Pharmaco-utilisation and related costs of drugs used to treat schizophrenia and bipolar disorder in Italy: the IBIS study.
abstract: BACKGROUND
  Schizophrenia and bipolar disorder (BD) are psychiatric diseases that are commonly managed with antipsychotics. Treatment pathways are highly variable and no universal treatment guidelines are available. The primary objective of the Italian Burden of Illness in Schizophrenia and BD (IBIS) study was to describe pharmaco-utilisation of antipsychotic treatments and characteristics of patients affected by schizophrenia or BD. A secondary objective was to describe costs of illness for patients with schizophrenia or BD.
  
  
  METHODS
  IBIS was a multicentre, real-world, retrospective, observational cohort study based on data obtained from administrative databases of 16 Local Health Units in Italy (~7.5 million individuals). Patients with schizophrenia or BD ≥18 years of age treated with antipsychotics between 1 January 2008 and 31 December 2009 were included in the primary analysis. Pharmaco-utilisation data were gathered over a follow-up period of 12 months.
  
  
  RESULTS
  Patients with schizophrenia and BD received a wide variety of antipsychotic medications. The proportion of patients on antipsychotic monotherapy was 68% in patients with schizophrenia and 70% in patients with BD. In patients with schizophrenia, ~1/3 of patients receiving antipsychotic monotherapy also received mood stabilisers and/or antidepressants (34.7%) compared with over half of those on antipsychotic polytherapy (52.2%). In patients with BD, use of mood stabilisers and/or antidepressants was even higher; 76.9% of patients receiving antipsychotic monotherapy also received mood stabilisers and/or antidepressants compared with 85.5% of patients on antipsychotic polytherapy. Switch therapy was more frequent in patients with BD than in patients with schizophrenia, whereas add-on therapy was more frequent in patients with schizophrenia than in patients with BD. The mean total disease-related cost per patient per annum was higher in patients with schizophrenia (€4,157) than in patients with BD (€3,301). The number and cost of hospitalisations was higher in patients with BD, whereas the number and cost of nursing home stays was higher in patients with schizophrenia.
  
  
  CONCLUSIONS
  Use of administrative databases has permitted retrieval of comprehensive information about therapeutic pathways, diagnostic history and costs in patients affected by schizophrenia or BD. A need for personalised treatment pathways has been described.
  
  
  BACKGROUND
  clinicaltrials.gov: NCT01392482 ; first received June 29, 2011.
authors.affiliation: Health, Economics, and Outcomes Research, CliCon Srl, Via Salara 36, Ravenna, I-48121, Italy. luca.degliesposti@clicon.it.
authors.forename: Luca
authors.initials: L
authors.lastname: Degli Esposti
authors.affiliation: Health, Economics, and Outcomes Research, CliCon Srl, Via Salara 36, Ravenna, I-48121, Italy. diego.sangiorgi@clicon.it.
authors.forename: Diego
authors.initials: D
authors.lastname: Sangiorgi
authors.affiliation: Depression Unit, Neuroscience Department, Fatebenefratelli Hospital, Milan, Italy. claudio.mencacci@gmail.com.
authors.forename: Claudio
authors.initials: C
authors.lastname: Mencacci
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy. espina@unime.it.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Spina
authors.affiliation: AstraZeneca Italy, Basiglio, Italy. carlotta.pasina@astrazeneca.com.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Pasina
authors.affiliation: AstraZeneca Italy, Basiglio, Italy. Marianna.Alacqua@astrazeneca.com.
authors.forename: Marianna
authors.initials: M
authors.lastname: Alacqua
authors.affiliation: AstraZeneca Italy, Basiglio, Italy. flore.latour@astrazeneca.com.
authors.forename: Flore
authors.initials: F
authors.lastname: la Tour
mesh_terms: D014150:Antipsychotic Agents / Q000191:economics* / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D015331:Cohort Studies; D017281:Cost of Illness; D016208:Databases, Factual / Q000191:economics; D016527:Drug Costs; D004363:Drug Utilization / Q000191:economics; D005260:Female; D006301:Health Services Needs and Demand / Q000191:economics; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012559:Schizophrenia / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents