Prevalence of Parkinson's disease-induced psychosis in a large U.S. managed care population.

Using 10 years' enrollment history, patients with non-drug-induced Parkinson's disease were identified, and the prevalence of Parkinson's disease-induced psychosis (PDP) was estimated using three different claims algorithms based on an expert working group criteria. The estimated prevalence of PDP ranged from 4 to 45/1,000 Parkinson's disease patients. PDP patients were just as likely to be male as female and were significantly older than Parkinson's disease patients without PDP. PDP patients more commonly had evidence of dementia and use of atypical antipsychotics. PDP occurs in up to 45,000 Parkinson's disease patients in the United States but represents a unique neuropsychiatric finding with important treatment implications.

The comparative effectiveness of rosuvastatin vs. other statins in patients with an increased risk of failure to reach NCEP ATP III goal.

BACKGROUND: Previous studies have demonstrated that failure to reach National Cholesterol Education Program (NCEP) target low-density lipoprotein cholesterol (LDL-C) goal increases the risk of cardiovascular events. Ability to meet goal may be impacted by the choice of statin therapy. PURPOSE: This study compares rosuvastatin to other statin therapies among patients presenting with risk factors associated with failure to reach NCEP goal. METHODS: Retrospective analysis using medical and pharmacy claims linked to laboratory results from a national health plan encompassing private and MedicareAdvantage enrollees age > or = 18 years and newly treated with statins from 1 August 2003 to 28 February 2005. Predictors of failure to reach goal were statin treatment group, age, gender, NCEP risk level, per cent reduction required to attain goal and days from index to LDL-C measurement. RESULTS: Of 11,814 eligible patients, 9.6% were initiated on rosuvastatin, 54.2% atorvastatin, 17.9% simvastatin, 7.1% pravastatin, 2.0% fluvastatin and 9.3% lovastatin. Independent predictors of failure to reach goal included > or = 15% LDL-C reduction required to reach goal, and high and moderate NCEP risk status. In the subset of patients at higher risk of failure to reach goal, rosuvastatin demonstrated a significantly lower rate of failure to achieve goal than atorvastatin, simvastatin, pravastatin, fluvastatin or lovastatin. CONCLUSIONS: Real-world factors associated with high risk of failure to reach goal may be used in identifying patients more likely to succeed on rosuvastatin compared with other statins. Low-risk patients needing < 15% LDL-C reduction would be suitable candidates for initiation of most other statins, specifically simvastatin, which has recently become available in the generic form.

Anticoagulation therapy in patients with chronic atrial fibrillation: a retrospective claims data analysis.

OBJECTIVES: This study assessed the risk of thrombo embolic events and bleeding complications among atrial fibrillation patients. METHODS: A cohort of patients with chronic non-valvular atrial fibrillation were identified from medical claims (diagnosis codes 427.31 and 427.32). Subjects were identified from 1 January 1998-31 December 2000 and were continuously enrolled for 6 months prior to the first occurring atrial fibrillation medical claim. Cox proportional hazards analysis with time varying covariates was used for the event analysis. RESULTS: Of 6764 subjects retained for analysis, 3541 (52.4%) were exposed to warfarin. Adjusting for baseline characteristics, warfarin exposure was associated with lower likelihood of an arterial thromboembolic event compared to no exposure (HR: 0.710, CI: 0.540-0.934). No benefit was found in the use of warfarin in the prevention of intracranial events (HR: 1.119, CI: 0.929-1.349). Use of warfarin increased the risk of minor bleeding events (HR: 3.600, CI: 2.537-5.109), and all bleeding events (HR: 1.502, CI: 1.289-1.749). CONCLUSIONS: The risk of arterial thromboembolic events was associated with warfarin exposure as expected. An increase in the risk of minor and total bleeding events among patients treated with warfarin was observed. The results of this study suggest that there may be a gap between the clinical trial and coagulation clinic performance of warfarin in reducing the risk of thromboembolic events versus what is achievable in general practice.