Antipsychotic use in the elderly up 35%, but costs up 749%, study finds

15/08/2005

Between 1993 and 2002, the number of elderly Ontarians using antipsychotics increased 35%, and the amount spent on these drugs went up nearly 750%, a new study from the Institute for Clinical Evaluative Sciences (ICES) and Sunnybrook and Women’s College Health Sciences Centre has found.

“What’s really been driving the growth of these medications is the increased use of newer, more expensive atypical antipsychotics to treat elderly patients with dementia. However, no one has taken a detailed look at the costs associated with this growth,” said lead author Dr. Mark Rapoport, a psychiatrist at Sunnybrook and Women’s College Health Sciences Centre.

To examine this issue, the study authors tracked trends in typical and atypical antipsychotic prescribing patterns, and their use and cost between 1993 and 2002 for more than 1.4 million elderly community-dwelling Ontarians aged 65 years and over.

Results:

The number of elderly Ontarians using antipsychotics increased proportionately by 35% over the study period, from 2.2% at the beginning of 1993 to 3.0% at the end of 2002.
This modest increase was associated with a 230% increase in total antipsychotic prescriptions (from 308,149 in 1993 to 1,015,450 in 2002), and a 749% increase in total cost (from $3.7 million in 1993 to $31.4 million in 2002).
Atypical antipsychotics, which were only made available in Ontario in the late 1990s, made up 83% of the antipsychotics dispensed and 95% of antipsychotic drug costs by 2002.

“These patterns are of particular concern because previous ICES research has suggested that atypical antipsychotics are only associated with modest improvements in dementia patients and may even be associated with important adverse events,” said study co-author and ICES scientist Dr. Paula Rochon.

“As our population ages and more people develop dementia and are treated with antipsychotics, and especially atypical antipsychotics, an understanding of the benefits of these medications must be balanced with a detailed understanding of their clinical and financial implications.”

The study, “Antipsychotic use in the elderly: shifting trends and increasing costs”, is in the August 2005 issue of the International Journal of Geriatric Psychiatry.

Author affiliations: ICES (Drs. Mamdani and Rochon); Sunnybrook and Women’s College Health Sciences Centre Department of Psychiatry (Drs. Rapoport, Shulman and Herrmann); Faculty of Pharmacy (Dr. Mamdani), and Faculty of Medicine (all authors), University of Toronto; Baycrest Centre for Geriatric Care (Dr. Rochon).

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

Sunnybrook and Women’s College Health Sciences Centre is transforming healthcare through the dedication of its more than 8,500 staff members who provide compassionate and innovative patient focused care. An internationally recognized leader in women’s health, academic research and education and an affiliation with the University of Toronto distinguishes Sunnybrook & Women’s as one of Canada’s premier health sciences centres. Sunnybrook & Women’s specializes in caring for newborns, adults and the elderly, treating and preventing cancer, heart and circulation diseases and complications, disorders of the brain, mind and nervous system, orthopaedic and arthritic conditions and traumatic injuries.