Healthcare utilisation and costs associated with adherence to antipsychotics among people living with HIV/AIDS and schizophrenia: a population-based cohort study in British Columbia, Canada
Objectives Non-adherence to antipsychotics is the greatest obstacle to treating schizophrenia. We assessed the economic and clinical impacts of adherence to antipsychotics among people living with HIV/AIDS (PLWH) and schizophrenia in British Columbia, Canada.Design and setting A population-based coh...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2023-04-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/4/e070680.full |
| _version_ | 1797843733684682752 |
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| author | Julio S G Montaner Ni Gusti Ayu Nanditha Hiwot M Tafessu Martin St-Jean Viviane D Lima Thomas L Patterson William G Honer Sony Subedi Hasan Nathani Julius Elefante |
| author_facet | Julio S G Montaner Ni Gusti Ayu Nanditha Hiwot M Tafessu Martin St-Jean Viviane D Lima Thomas L Patterson William G Honer Sony Subedi Hasan Nathani Julius Elefante |
| author_sort | Julio S G Montaner |
| collection | DOAJ |
| description | Objectives Non-adherence to antipsychotics is the greatest obstacle to treating schizophrenia. We assessed the economic and clinical impacts of adherence to antipsychotics among people living with HIV/AIDS (PLWH) and schizophrenia in British Columbia, Canada.Design and setting A population-based cohort study in British Columbia, Canada.Methods Eligible PLWH were enrolled in the Seek and Treat for Optimal Prevention HIV/AIDS population-based cohort during 2001–2016, diagnosed with schizophrenia, on antipsychotics for ≥1 day, and followed for ≥1 year from schizophrenia diagnosis date or 1 January 2001, whichever occurred last.Primary and secondary outcome measures A two-part model assessed the marginal effect of adherence on healthcare costs (in 2016 Canadian dollar), while logistic regression examined the effect on virological failure, and generalised linear mixed models examined the effect on hospital readmissions within 30 days and length of hospital stay.Results Among 726 PLWH with schizophrenia, ≥80% adherence to antipsychotics increased from 25% (50/198) in 2001 to 41% (225/554) in 2016. In most years, we observed no difference in adherence to antipsychotics among those who used only injectables, only non-injectables, and a combination of both, or among those who have ever consumed typical/first-generation antipsychotics and who consumed only atypical/second-generation antipsychotics. Overall healthcare costs were higher in the non-adherent group ($C2185), driven by the average annual hospitalisation costs ($C5517), particularly among women ($C8806) and people who ever injected drugs (PWID) ($C5985). Non-adherent individuals also experienced higher hospital readmissions (adjusted odds ratio (aOR) 1.48, 95% CI 1.23 to 1.77), and longer hospital stays (adjusted mean ratio 1.23, 95% CI 1.13 to 1.35) in comparison to adherent individuals. We found no difference in virological failure by adherence groups, except when we stratified by gender where the aOR for women was 2.48 (95% CI 1.06 to 5.82).Conclusions Our results showed that implementing strategies and interventions to increase antipsychotic adherence, particularly among women and PWID, will be critical in addressing this public health challenge. |
| first_indexed | 2024-04-09T17:10:36Z |
| format | Article |
| id | doaj.art-b51100fc2d9d484bb26d93cd010ee1b1 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-04-09T17:10:36Z |
| publishDate | 2023-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-b51100fc2d9d484bb26d93cd010ee1b12023-04-20T06:30:06ZengBMJ Publishing GroupBMJ Open2044-60552023-04-0113410.1136/bmjopen-2022-070680Healthcare utilisation and costs associated with adherence to antipsychotics among people living with HIV/AIDS and schizophrenia: a population-based cohort study in British Columbia, CanadaJulio S G Montaner0Ni Gusti Ayu Nanditha1Hiwot M Tafessu2Martin St-Jean3Viviane D Lima4Thomas L Patterson5William G Honer6Sony Subedi7Hasan Nathani8Julius Elefante9The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, CanadaBritish Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, CanadaBritish Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, CanadaBritish Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, CanadaBritish Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada3Department of Psychiatry, University of California, San Diego, La Jolla, USA1Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, CanadaBritish Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, CanadaBritish Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, CanadaDepartment of Psychiatry, The University of British Columbia, Vancouver, British Columbia, CanadaObjectives Non-adherence to antipsychotics is the greatest obstacle to treating schizophrenia. We assessed the economic and clinical impacts of adherence to antipsychotics among people living with HIV/AIDS (PLWH) and schizophrenia in British Columbia, Canada.Design and setting A population-based cohort study in British Columbia, Canada.Methods Eligible PLWH were enrolled in the Seek and Treat for Optimal Prevention HIV/AIDS population-based cohort during 2001–2016, diagnosed with schizophrenia, on antipsychotics for ≥1 day, and followed for ≥1 year from schizophrenia diagnosis date or 1 January 2001, whichever occurred last.Primary and secondary outcome measures A two-part model assessed the marginal effect of adherence on healthcare costs (in 2016 Canadian dollar), while logistic regression examined the effect on virological failure, and generalised linear mixed models examined the effect on hospital readmissions within 30 days and length of hospital stay.Results Among 726 PLWH with schizophrenia, ≥80% adherence to antipsychotics increased from 25% (50/198) in 2001 to 41% (225/554) in 2016. In most years, we observed no difference in adherence to antipsychotics among those who used only injectables, only non-injectables, and a combination of both, or among those who have ever consumed typical/first-generation antipsychotics and who consumed only atypical/second-generation antipsychotics. Overall healthcare costs were higher in the non-adherent group ($C2185), driven by the average annual hospitalisation costs ($C5517), particularly among women ($C8806) and people who ever injected drugs (PWID) ($C5985). Non-adherent individuals also experienced higher hospital readmissions (adjusted odds ratio (aOR) 1.48, 95% CI 1.23 to 1.77), and longer hospital stays (adjusted mean ratio 1.23, 95% CI 1.13 to 1.35) in comparison to adherent individuals. We found no difference in virological failure by adherence groups, except when we stratified by gender where the aOR for women was 2.48 (95% CI 1.06 to 5.82).Conclusions Our results showed that implementing strategies and interventions to increase antipsychotic adherence, particularly among women and PWID, will be critical in addressing this public health challenge.https://bmjopen.bmj.com/content/13/4/e070680.full |
| spellingShingle | Julio S G Montaner Ni Gusti Ayu Nanditha Hiwot M Tafessu Martin St-Jean Viviane D Lima Thomas L Patterson William G Honer Sony Subedi Hasan Nathani Julius Elefante Healthcare utilisation and costs associated with adherence to antipsychotics among people living with HIV/AIDS and schizophrenia: a population-based cohort study in British Columbia, Canada BMJ Open |
| title | Healthcare utilisation and costs associated with adherence to antipsychotics among people living with HIV/AIDS and schizophrenia: a population-based cohort study in British Columbia, Canada |
| title_full | Healthcare utilisation and costs associated with adherence to antipsychotics among people living with HIV/AIDS and schizophrenia: a population-based cohort study in British Columbia, Canada |
| title_fullStr | Healthcare utilisation and costs associated with adherence to antipsychotics among people living with HIV/AIDS and schizophrenia: a population-based cohort study in British Columbia, Canada |
| title_full_unstemmed | Healthcare utilisation and costs associated with adherence to antipsychotics among people living with HIV/AIDS and schizophrenia: a population-based cohort study in British Columbia, Canada |
| title_short | Healthcare utilisation and costs associated with adherence to antipsychotics among people living with HIV/AIDS and schizophrenia: a population-based cohort study in British Columbia, Canada |
| title_sort | healthcare utilisation and costs associated with adherence to antipsychotics among people living with hiv aids and schizophrenia a population based cohort study in british columbia canada |
| url | https://bmjopen.bmj.com/content/13/4/e070680.full |
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