(354) Healthcare resource utilization following cariprazine initiation among medicare beneficiaries with bipolar I disorder

Background: : Cariprazine, a dopamine D3 preferring D3/D2 and serotonin 5-HT1A receptor partial agonist atypical antipsychotic (AA) approved in USA for treating schizophrenia, mania/mixed and depressive episodes associated with bipolar I disorder (BP-I), and for the adjunctive treatment of Major Depressive Disorder. The impact of cariprazine on clinical outcomes and healthcare resource utilization (HCRU) in BP-I patients is known, but there is limited real-world evidence for its initiation among Medicare Fee-for-Service beneficiaries.

Objective: : Compare all-cause HCRU before vs. after cariprazine initiation in Medicare FFS beneficiaries with BP-I.

Methods: : A retrospective observational study using administrative claims data from the Centers for Medicare & Medicaid Services 100% Research Identifiable Files included Medicare FFS beneficiaries ≥18 years with BP-I initiating cariprazine (index date=first claim) January 1, 2019 to June 30, 2022 with 6-months pre- and post-index continuous enrollment in Medicare Parts A, B, and D. The post-index period lasted during continuous cariprazine treatment from index date until the earliest of the following: discontinuation (≥45-day gap), exposure to a different oral AA, exposure to a long-acting injectable antipsychotic, death, disenrollment from the database or end of the study. Patients were required to have 6 months of continuous cariprazine use post-index. All-cause HCRU (inpatient, emergency room [ER], outpatient) was assessed during the pre- and post-index periods and compared using paired t-tests and McNemar tests for continuous and categorical variables, respectively. P-values < 0.05 were considered significant.

Results: : 1,655 Medicare FFS beneficiaries were included. Mean age(standard deviation [SD]) at index was 50.8(13.7) years; 74.4% were female, 84.4% were White. Mean(SD) Charlson Comorbidity Index score was 1.1(1.5), 74.9% of beneficiaries were dual-eligible. Beneficiaries with ≥1 all-cause inpatient hospitalization during the 6-month post-index significantly decreased vs pre-index (pre- vs. post-index: 15.4% vs. 10.3%, p< 0.0001). Mean all-cause hospitalizations also significantly decreased post- vs. pre-index (0.22 vs. 0.14, p< 0.0001). Beneficiaries with ≥1 all-cause ER visit and mean number of ER visits were significantly lower post- vs pre-index (41.3% vs. 33.9%; 1.01 vs. 0.77; all p< 0.0001). Outpatient visits were not significantly different post- vs. pre-index (22.62 vs. 22.07, p>0.05).

Conclusions: : All-cause HCRU was significantly lower after cariprazine initiation, highlighting the real-world economic value of cariprazine in reducing HCRU burden.

Sponsorship:: AbbVie