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Atypical antipsychotics not associated with improved hospitalisation outcomes compared with typical antipsychotics in people with schizophrenia in real practice

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Question: What is the effectiveness and cost of atypical versus typical antipsychotic treatment in people with schizophrenia in real practice?

Population: A total of 8610 adults (mean age 41.5 years, range 16–92 years, 55.4% male) with schizophrenia (International Classification of Diseases (ICD)-10) who were members of four sickness funds met inclusion criteria: complete data on membership available, membership continued throughout study period, aged >16 years and taking prescribed antipsychotics.

Setting: Germany: 2003–2004.

Prognostic factors: Type of antipsychotic prescribed, gender, age and disease severity. Antipsychotic types were high-potency typical antipsychotics 15.8% (n=1356); atypical antipsychotics 35.3% (n=3040); atypical plus high-potency typical antipsychotics 24.7% (n=2126) or atypical with adjuvant therapy 15.6% (n=1341). Drug switching within a drug class was more common for people on typical antipsychotics compared with atypical antipsychotics (55.3% vs 24.9%, p<0.0001). To reduce bias and heterogeneity, analyses were mainly in people who did not switch drugs (atypical 26.5%, n=2284; typical 7%, n=606). Severity of disease was assessed based on days of prior hospitalisation with any diagnosis of schizophrenia.

Outcomes: Rehospitalisation rates; bed days during follow-up; costs of …

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