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New start versus continuing users on aripiprazole: implications for policy.

Rashid Kazerooni1, Joseph B Nguyen, Mark Bounthavong

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New aripiprazole users had lower adherence and refill rates with 90-day supplies compared to continuing users. Initial 30-day prescriptions are recommended for new patients to ensure effectiveness and tolerance.

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Area of Science:

  • Pharmacoeconomics
  • Psychiatric Pharmacy
  • Health Services Research

Background:

  • Aripiprazole is a widely used atypical antipsychotic.
  • Optimizing medication adherence and resource utilization is crucial for effective treatment.
  • Prescription supply length can influence patient adherence and medication waste.

Purpose of the Study:

  • To evaluate the utilization of 90-day prescriptions for aripiprazole.
  • To compare medication adherence between new and continuing aripiprazole users receiving 90-day supplies.
  • To assess the odds of adherence and refilling associated with new versus continuing aripiprazole prescriptions.

Main Methods:

  • Retrospective cohort study of 749 patients from the Veterans Affairs San Diego Healthcare System (April 2011-March 2012).
  • Primary outcome: difference in adherence (Medication Possession Ratio [MPR] ≥ 0.8) between new and continuing aripiprazole users.
  • Secondary outcomes: odds of adherence and refilling at least once for new users compared to continuing users.

Main Results:

  • A significant proportion of both new (41.2%) and continuing (69.1%) users received 90-day supplies.
  • New aripiprazole users demonstrated significantly lower MPR than continuing users (-0.13; 95% CI, -0.18 to -0.08).
  • New users had lower odds of adherence (OR, 0.46; 95% CI, 0.33-0.65) and refilling (OR, 0.43; 95% CI, 0.28-0.66) compared to continuing users.

Conclusions:

  • Continuing aripiprazole users were more likely to be adherent and refill their prescriptions.
  • Overutilization of 90-day supplies, especially for new patients, may lead to medication waste.
  • Initiating high-cost medications like aripiprazole with 30-day supplies is recommended until effectiveness and tolerance are established.