title: Trends in the use and cost of antipsychotics among older adults from 2007 to 2013: a repeated cross-sectional study.
abstract: BACKGROUND
  Recently, several new atypical antipsychotic agents have been introduced in Ontario, and regulatory warnings have been issued regarding use of atypical antipsychotics in older adults. We sought to establish the impact of newer atypical antipsychotics on prescribing rates and costs.
  
  
  METHODS
  We performed a population-based cross-sectional study of Ontario adults aged 65 years or more using atypical antipsychotics from Jan. 1, 2007, to Mar. 31, 2013. These people have universal access to publicly funded drugs through the Ontario Health Insurance Plan and the Ontario Drug Benefit. We conducted time-series analysis to assess the impact of the introduction of new atypical antipsychotics on rates of use of atypical antipsychotics and associated expenditures.
  
  
  RESULTS
  Rates of atypical antipsychotic use increased following the introduction of new agents in 2009, from 27.6 users per 1000 older adults in the third quarter of 2009 to 29.1 users per 1000 older adults at the end of the study period (p = 0.04). Although prescribing rates for the newer atypical agents (paliperidone, ziprasidone and aripiprazole) remained low relative to their older counterparts (risperidone, olanzapine and quetiapine), rates of aripiprazole use rose to 1.0 user per 1000 older adults by the end of the study period. The proportion of prescriptions that were for brand-name agents fell from 57.5% in the second quarter of 2007 to 6.1% in the second quarter of 2009, and then rose to 11.7% by the end of the study period. By the first quarter of 2013, newer atypical antipsychotic agents were used by 4.4% of atypical antipsychotic users but accounted for 14.1% ($1.2 million of $8.5 million) of atypical antipsychotic expenditures.
  
  
  CONCLUSIONS
  Although the overall prevalence of use of new atypical antipsychotic agents remains low, their introduction has led to increased prescribing of this class of drugs in older adults. Given the potential cost implications, further study of these trends would be prudent.
authors.affiliation: Schulich School of Medicine and Dentistry (Foster), Western University, London; Institute for Clinical Evaluative Sciences (Camacho, Vigod, Yao, Juurlink, Paterson, Mamdani, Martins, Gomes), Toronto; Applied Health Research Centre (Foster, Mamdani, Gomes), St. Michael's Hospital, Toronto; Women's College Hospital and Research Institute (Vigod), Toronto; Departments of Medicine (Juurlink)and Psychiatry (Vigod) and Institute of Health Policy, Management and Evaluation (Vigod, Juurlink, Paterson, Mamdani, Gomes), University of Toronto, Toronto; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont. Paul Foster, David Juurlink, Michael Paterson, Muhammad Mamdani and Tara Gomes conceived the study. Ximena Camacho, Zhan Yao and Diana Martins acquired the data. Paul Foster and Tara Gomes drafted the manuscript, and Simone Vigod, David Juurlink, Michael Paterson, Muhammad Mamdani and Tara Gomes revised the manuscript for important intellectual content. All of the authors designed the study, contributed to data analysis and interpretation, gave approval of the final version to be published and agreed to act as guarantors of the work.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Foster
authors.affiliation: Schulich School of Medicine and Dentistry (Foster), Western University, London; Institute for Clinical Evaluative Sciences (Camacho, Vigod, Yao, Juurlink, Paterson, Mamdani, Martins, Gomes), Toronto; Applied Health Research Centre (Foster, Mamdani, Gomes), St. Michael's Hospital, Toronto; Women's College Hospital and Research Institute (Vigod), Toronto; Departments of Medicine (Juurlink)and Psychiatry (Vigod) and Institute of Health Policy, Management and Evaluation (Vigod, Juurlink, Paterson, Mamdani, Gomes), University of Toronto, Toronto; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont. Paul Foster, David Juurlink, Michael Paterson, Muhammad Mamdani and Tara Gomes conceived the study. Ximena Camacho, Zhan Yao and Diana Martins acquired the data. Paul Foster and Tara Gomes drafted the manuscript, and Simone Vigod, David Juurlink, Michael Paterson, Muhammad Mamdani and Tara Gomes revised the manuscript for important intellectual content. All of the authors designed the study, contributed to data analysis and interpretation, gave approval of the final version to be published and agreed to act as guarantors of the work.
authors.forename: Ximena
authors.initials: X
authors.lastname: Camacho
authors.affiliation: Schulich School of Medicine and Dentistry (Foster), Western University, London; Institute for Clinical Evaluative Sciences (Camacho, Vigod, Yao, Juurlink, Paterson, Mamdani, Martins, Gomes), Toronto; Applied Health Research Centre (Foster, Mamdani, Gomes), St. Michael's Hospital, Toronto; Women's College Hospital and Research Institute (Vigod), Toronto; Departments of Medicine (Juurlink)and Psychiatry (Vigod) and Institute of Health Policy, Management and Evaluation (Vigod, Juurlink, Paterson, Mamdani, Gomes), University of Toronto, Toronto; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont. Paul Foster, David Juurlink, Michael Paterson, Muhammad Mamdani and Tara Gomes conceived the study. Ximena Camacho, Zhan Yao and Diana Martins acquired the data. Paul Foster and Tara Gomes drafted the manuscript, and Simone Vigod, David Juurlink, Michael Paterson, Muhammad Mamdani and Tara Gomes revised the manuscript for important intellectual content. All of the authors designed the study, contributed to data analysis and interpretation, gave approval of the final version to be published and agreed to act as guarantors of the work.
authors.forename: Simone
authors.initials: S
authors.lastname: Vigod
authors.affiliation: Schulich School of Medicine and Dentistry (Foster), Western University, London; Institute for Clinical Evaluative Sciences (Camacho, Vigod, Yao, Juurlink, Paterson, Mamdani, Martins, Gomes), Toronto; Applied Health Research Centre (Foster, Mamdani, Gomes), St. Michael's Hospital, Toronto; Women's College Hospital and Research Institute (Vigod), Toronto; Departments of Medicine (Juurlink)and Psychiatry (Vigod) and Institute of Health Policy, Management and Evaluation (Vigod, Juurlink, Paterson, Mamdani, Gomes), University of Toronto, Toronto; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont. Paul Foster, David Juurlink, Michael Paterson, Muhammad Mamdani and Tara Gomes conceived the study. Ximena Camacho, Zhan Yao and Diana Martins acquired the data. Paul Foster and Tara Gomes drafted the manuscript, and Simone Vigod, David Juurlink, Michael Paterson, Muhammad Mamdani and Tara Gomes revised the manuscript for important intellectual content. All of the authors designed the study, contributed to data analysis and interpretation, gave approval of the final version to be published and agreed to act as guarantors of the work.
authors.forename: Zhan
authors.initials: Z
authors.lastname: Yao
authors.affiliation: Schulich School of Medicine and Dentistry (Foster), Western University, London; Institute for Clinical Evaluative Sciences (Camacho, Vigod, Yao, Juurlink, Paterson, Mamdani, Martins, Gomes), Toronto; Applied Health Research Centre (Foster, Mamdani, Gomes), St. Michael's Hospital, Toronto; Women's College Hospital and Research Institute (Vigod), Toronto; Departments of Medicine (Juurlink)and Psychiatry (Vigod) and Institute of Health Policy, Management and Evaluation (Vigod, Juurlink, Paterson, Mamdani, Gomes), University of Toronto, Toronto; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont. Paul Foster, David Juurlink, Michael Paterson, Muhammad Mamdani and Tara Gomes conceived the study. Ximena Camacho, Zhan Yao and Diana Martins acquired the data. Paul Foster and Tara Gomes drafted the manuscript, and Simone Vigod, David Juurlink, Michael Paterson, Muhammad Mamdani and Tara Gomes revised the manuscript for important intellectual content. All of the authors designed the study, contributed to data analysis and interpretation, gave approval of the final version to be published and agreed to act as guarantors of the work.
authors.forename: David N
authors.initials: DN
authors.lastname: Juurlink
authors.affiliation: Schulich School of Medicine and Dentistry (Foster), Western University, London; Institute for Clinical Evaluative Sciences (Camacho, Vigod, Yao, Juurlink, Paterson, Mamdani, Martins, Gomes), Toronto; Applied Health Research Centre (Foster, Mamdani, Gomes), St. Michael's Hospital, Toronto; Women's College Hospital and Research Institute (Vigod), Toronto; Departments of Medicine (Juurlink)and Psychiatry (Vigod) and Institute of Health Policy, Management and Evaluation (Vigod, Juurlink, Paterson, Mamdani, Gomes), University of Toronto, Toronto; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont. Paul Foster, David Juurlink, Michael Paterson, Muhammad Mamdani and Tara Gomes conceived the study. Ximena Camacho, Zhan Yao and Diana Martins acquired the data. Paul Foster and Tara Gomes drafted the manuscript, and Simone Vigod, David Juurlink, Michael Paterson, Muhammad Mamdani and Tara Gomes revised the manuscript for important intellectual content. All of the authors designed the study, contributed to data analysis and interpretation, gave approval of the final version to be published and agreed to act as guarantors of the work.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Paterson
authors.affiliation: Schulich School of Medicine and Dentistry (Foster), Western University, London; Institute for Clinical Evaluative Sciences (Camacho, Vigod, Yao, Juurlink, Paterson, Mamdani, Martins, Gomes), Toronto; Applied Health Research Centre (Foster, Mamdani, Gomes), St. Michael's Hospital, Toronto; Women's College Hospital and Research Institute (Vigod), Toronto; Departments of Medicine (Juurlink)and Psychiatry (Vigod) and Institute of Health Policy, Management and Evaluation (Vigod, Juurlink, Paterson, Mamdani, Gomes), University of Toronto, Toronto; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont. Paul Foster, David Juurlink, Michael Paterson, Muhammad Mamdani and Tara Gomes conceived the study. Ximena Camacho, Zhan Yao and Diana Martins acquired the data. Paul Foster and Tara Gomes drafted the manuscript, and Simone Vigod, David Juurlink, Michael Paterson, Muhammad Mamdani and Tara Gomes revised the manuscript for important intellectual content. All of the authors designed the study, contributed to data analysis and interpretation, gave approval of the final version to be published and agreed to act as guarantors of the work.
authors.forename: Muhammad M
authors.initials: MM
authors.lastname: Mamdani
authors.affiliation: Schulich School of Medicine and Dentistry (Foster), Western University, London; Institute for Clinical Evaluative Sciences (Camacho, Vigod, Yao, Juurlink, Paterson, Mamdani, Martins, Gomes), Toronto; Applied Health Research Centre (Foster, Mamdani, Gomes), St. Michael's Hospital, Toronto; Women's College Hospital and Research Institute (Vigod), Toronto; Departments of Medicine (Juurlink)and Psychiatry (Vigod) and Institute of Health Policy, Management and Evaluation (Vigod, Juurlink, Paterson, Mamdani, Gomes), University of Toronto, Toronto; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont. Paul Foster, David Juurlink, Michael Paterson, Muhammad Mamdani and Tara Gomes conceived the study. Ximena Camacho, Zhan Yao and Diana Martins acquired the data. Paul Foster and Tara Gomes drafted the manuscript, and Simone Vigod, David Juurlink, Michael Paterson, Muhammad Mamdani and Tara Gomes revised the manuscript for important intellectual content. All of the authors designed the study, contributed to data analysis and interpretation, gave approval of the final version to be published and agreed to act as guarantors of the work.
authors.forename: Diana
authors.initials: D
authors.lastname: Martins
authors.affiliation: Schulich School of Medicine and Dentistry (Foster), Western University, London; Institute for Clinical Evaluative Sciences (Camacho, Vigod, Yao, Juurlink, Paterson, Mamdani, Martins, Gomes), Toronto; Applied Health Research Centre (Foster, Mamdani, Gomes), St. Michael's Hospital, Toronto; Women's College Hospital and Research Institute (Vigod), Toronto; Departments of Medicine (Juurlink)and Psychiatry (Vigod) and Institute of Health Policy, Management and Evaluation (Vigod, Juurlink, Paterson, Mamdani, Gomes), University of Toronto, Toronto; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont. Paul Foster, David Juurlink, Michael Paterson, Muhammad Mamdani and Tara Gomes conceived the study. Ximena Camacho, Zhan Yao and Diana Martins acquired the data. Paul Foster and Tara Gomes drafted the manuscript, and Simone Vigod, David Juurlink, Michael Paterson, Muhammad Mamdani and Tara Gomes revised the manuscript for important intellectual content. All of the authors designed the study, contributed to data analysis and interpretation, gave approval of the final version to be published and agreed to act as guarantors of the work.
authors.forename: Tara
authors.initials: T
authors.lastname: Gomes