Extrapyramidal Symptoms in Schizophrenia Associated With Higher Healthcare Costs

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Extrapyramidal symptoms that developed in patients with schizophrenia after initiation of treatment with atypical antipsychotic agents were associated with increased healthcare resources and costs.

The following article is a part of conference coverage from Psych Congress 2020 Virtual Experience, held virtually from September 10 to 13, 2020. The team at Psychiatry Advisor will be reporting on the latest news and research conducted by leading experts in psychiatry. Check back for more from the Psych Congress 2020.


Extrapyramidal symptoms (EPS) that developed in patients with schizophrenia after initiating treatment with an atypical antipsychotic were associated with increased healthcare resources and costs, according to findings presented at Psych Congress 2020, held virtually from September 10 to 13, 2020.

Researchers conducted a retrospective, administrative claims-based analysis of Medicaid patients newly initiating treatment with atypical antipsychotics to determine the economic burden of EPS in schizophrenia. The MarketScan Multi-State Medicaid database was used to identify patients with schizophrenia who started treatment with atypical antipsychotics without previous incidence of EPS from January 1, 2012, through December 31, 2018.

EPS were defined using diagnoses and medications from the International Classification of Diseases, Ninth and Tenth revisions. The researchers assessed demographics, clinical characteristics, healthcare resource use, and costs during a 12-month period following either the first EPS claim or a randomly assigned index date (non-EPS).

A total of 11,642 patients with schizophrenia were included: 2295 with EPS (mean age, 38 years; 61% men) and 5607 without EPS (mean age, 39; 57% men). EPS developed in 19.7% within 12 months following initiation of atypical antipsychotics (incidence, 23.6/100 person-years).

The cohort with EPS had significantly higher rates of all-cause hospitalizations (30.2% vs 24.6%; P <.001), schizophrenia-related hospitalizations (22.5% vs 12.9%; P <.001), and schizophrenia-related emergency department visits (25.5% vs 16.7%; P <.001) compared with the non-EPS cohort. In addition, all-cause healthcare costs ($25,911 vs $21,550; P <.001) and schizophrenia-related healthcare costs ($12,134 vs $6,230; P <.001) were significantly higher in patients with EPS vs those without EPS.

Study limitations included the lack of generalizability to patients with insurance other than Medicaid; the potential for misclassification when using administrative claims; and the lack of clinical data (eg, Positive and Negative Syndrome Scale), which meant that researchers could not control for disease severity.

“Treatment options that minimize EPS may reduce the economic burden of schizophrenia,” the researchers wrote.

Disclosure: This study was supported by Sunovion. Please see the original reference for a full list of authors’ disclosures. 

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Kadakia A, Brady B, Huang H, et al. The incidence and economic burden of extrapyramidal symptoms in patients with schizophrenia treated with atypical antipsychotics. Presented at: Psych Congress 2020 Virtual Experience; September 10-13, 2020. Poster 207.