Fan, H

Guo, JJ

Jing, Y

Keck, P

Kelton, CM

Patel, NC

Wu, JH

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z-scores and odds of0.5 change in baseline to follow-up z-scores
were estimated. RESULTS: A total of 1179 eligible patients were
identiﬁed with mean age 15.2 years (SD, 2.16) and 51% female.
The distribution was: FGA’s 19% (n = 253), aripiprazole 11%
(n = 129), olanzapine 15% (n = 182), quetiapine 25% (n = 297),
risperidone 26% (n = 308), and ziprasidone 3% (n = 32). In the
linear model, adolescents on olanzapine experienced a signiﬁcant
increase in BMI [0.84 kg/m2 (CI, 0.17–1.52)] compared to those
on aripiprazole. Logistic model results indicated a signiﬁcant
likelihood of a 5 to 20% increase in BMI for those on olanzapine
[OR: 1.54 (CI, 0.96–2.5) to 4.53 (CI, 1.79–11.48) and a 10 to
20% increase for those on risperidone [OR: 1.84 (CI, 1.15–3.0) to
2.18 (CI, 1.21–3.96)], compared to aripiprazole. In the BMI
z-score analysis, adolescents on olanzapine experienced a signiﬁ-
cant increase in BMI [OR: 1.65 (CI, 1.02–2.67)]. Results for
FGA’s, quetiapine, and ziprasidone were not statistically signiﬁ-
cant. CONCLUSION: Potential for weight gain varies by anti-
psychotics and should be taken into account while prescribing
these medications to adolescents.
MH2
ECONOMIC AND CLINICAL CONSEQUENCES ASSOCIATED
WITH POTENTIAL DRUG-DRUG INTERACTIONS BETWEEN
ANTIPSYCHOTICS AND CONCOMITANT MEDICATIONS IN
PATIENTSWITH SCHIZOPHRENIA
Guo JJ1, Kelton CM1, Patel NC1,Wu JH2, Jing Y1, Fan H3, Keck P1
1University of Cincinnati, Cincinnati, OH, USA, 2Ortho-McNeil Janssen
Scientiﬁc Affairs, LLC,Titusville, NJ, USA, 3Covance Inc, Sun Prairie,WI,
USA
OBJECTIVE: Inhibiting or inducing antipsychotic metabolism
via the hepatic cytochrome P450 (CYP450) may have clinical
and economic consequences. This study examined whether
drug-drug interactions (DDIs) between oral antipsychotics and
non-antipsychotic concomitant medications that are inhibitors or
inducers of CYP450 isoenzymes are associated with increased
health care utilization and costs in schizophrenics or
schizoaffective-disorder patients. METHODS: Ohio State Med-
icaid data contributed patients (18  age < 65) who had schizo-
phrenia or schizoaffective disorder and received an antipsychotic
from 2000 to 2003 (N = 31,716). Clinically signiﬁcant DDI pair-
ings (Facts & Comparisons 4.0) were examined, with concomi-
tant exposure for an antipsychotic prescription overlapping with
an interacting medication. Three adverse events (AEs) (extrapy-
ramidal symptoms, increased seizure risk and QT-prolongation
or arrhythmias) associated with DDIs were studied. Utilization
and costs for inpatient and ambulatory care during a 90-day
follow-up were examined. Regression analyses were used to
adjust for confounding factors between patient groups.
RESULTS: Most patients had non-DDI (26,546); 7060 had a
DDI (no AE) and 110 experienced DDI + AE. Length of stay
and emergency room visits (mean  SD) were highest for DDI +
AE (25 days  17.8; 3.4  4.1) and lower for the DDI
(11 days  9.9; 1.5  1.0) and non-DDI (3.6 days  15.6;
0.5  2.8) groups. Health care costs were higher with DDI + AE
($9699) or DDI ($2962) compared with non-DDI ($2201).
Regression analysis indicated that patients with DDI + AE or
DDI had signiﬁcantly higher health care utilization and costs
than patients without DDI (P < 0.001). Stepwise regression
showed that patients with a DDI or DDI + AE associated with
olanzapine, risperidone and quetiapine had higher total costs
than patients without a DDI. CONCLUSION: These data
suggest that antipsychotic DDIs are related to higher health care
utilization and costs. Efforts to avoid potential DDIs associated
with some antipsychotics are critical for clinical practitioners to
prevent costly clinical and economic consequences.
MH3
WORK ABSENTEEISM AND BED DAYS IN CHRONIC MEDICAL
DISORDER PATIENTSWITH ANDWITHOUT DEPRESSION IN
THE UNITED STATES, 2004–2005
Sankaranarayanan J, Smith LM, Meza J, Burke WJ
University of Nebraska Medical Center, Omaha, NE, USA
OBJECTIVE: Study of depression on disability days and work
absenteeism in patients with chronic medical disorders (CMDs)
is limited. Our objective was to compare annual bed days and
missed workdays in CMD patients with and without depression.
METHODS: For retrospective analysis, we extracted data on
>/=18 year-old employed adults from the pooled 2004–5 Medical
Expenditure Panel Survey. Data included ICD-9-CM-coded
CMD (hyperlipidemia, heart-disease, arthritis/other joint-
disorders, chronic obstructive pulmonary disease, hypertension,
diabetes), and depression; number of missed workdays and bed
days, age, gender, race, poverty level, health insurance, health
status (physical, mental), urban residence, and any depression
treatment (psychotherapy/antidepressant). For 6786 CMD
patients with and without depression, we compared rates with
one or more missed workdays and bed days, and mean number
of missed workdays and bed days. Weighted sample estimates
and 95 percent conﬁdence limits (CL) were calculated using the
Taylor expansion method. In multivariate logistic regression
models, after controlling for other characteristics, we examined
association of depression with one or more missed workdays and
one or more bed days. RESULTS: Compared with those without
depression, signiﬁcantly more CMD patients with depression
reported one or more missed workdays [50.26% (SE0.86%) vs.
70.14% (SE2.11%) p < 0.001], and one or more bed days
[18.51% (SE0.66%) vs. 34.24% (SE2.2%), p < 0.001]. The
mean number of missed workdays (9.93+/-0.94 vs. 5.01+/-0.22)
and bed days (4.29+/-0.62 vs. 1.03+/-0.08) were also higher in
CMD with versus without depression. In multivariate analyses,
after controlling for other characteristics including any depres-
sion treatment, depression increased the likelihood of one or
more missed workdays (adjusted Odds-Ratio, OR 1.41, 95%
CL:1.14–1.75, p = 0.002) and one or more bed days (OR 1.37,
95% CL:1.07–1.75, p = 0.013) in CMD patients. CONCLU-
SION: Depression plays a signiﬁcant role in both absenteeism
and bed days in CMD patients in the United States. Effective
identiﬁcation and treatment strategies require the attention of
both providers and payers.
MH4
TREATMENT COST AND COMORBIDITIES ASSOCIATEDWITH
OBESITY AMONG CHILDREN AND ADOLESCENTSWITH
BIPOLAR DISORDER
Guo JJ1, Kelton CM1, Jing Y1, Patel NC2
1University of Cincinnati, Cincinnati, OH, USA, 2University of Georgia,
Augusta, GA, USA
OBJECTIVE: Childhood obesity as a known risk factor associ-
ated with bipolar disorder complicates its treatment. The
purpose of this study is to assess treatment costs and comorbidi-
ties associated with obesity in children and adolescents with
bipolar disorder. METHODS: Based on a multi-state managed
care medical claims database (PharMetrics), a total of 9895
children and adolescents (6 < age < 19) who had been diagnosed
and received medication treatment for bipolar disorder during
the period January 1, 1998 to December 31, 2002 were selected
for this study. Annual treatment cost per patient was constructed
as the sum of reimbursed amounts (in 2002 constant dollars) for
hospitalizations, outpatient care, emergency room (ER) visits,
physician encounters, laboratory tests, drugs, and other medical
services. A stepwise log-linear regression analysis was used to
Abstracts A7


MH2 ECONOMIC AND CLINICAL CONSEQUENCES ASSOCIATED WITH POTENTIAL DRUG-DRUG INTERACTIONS BETWEEN ANTIPSYCHOTICS AND CONCOMITANT MEDICATIONS IN PATIENTS WITH SCHIZOPHRENIA 

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MH2 ECONOMIC AND CLINICAL CONSEQUENCES ASSOCIATED WITH POTENTIAL DRUG-DRUG INTERACTIONS BETWEEN ANTIPSYCHOTICS AND CONCOMITANT MEDICATIONS IN PATIENTS WITH SCHIZOPHRENIA

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