1. Military Health System Prescribing Patterns Associated with Psychotropic Medications, by Cancer Type, FY07-FY14
Michelle Kloc, Ph.D.,1 Diana D. Jeffery, Ph.D.,2 Joe Dorris, M.A.,1 and Harry Burke, M.D., Ph.D.3
1 Altarum Institute, Alexandria, VA and Ann Arbor, MI; 2 Department of Defense, Defense Health Agency, Falls Church, VA; 3 DoD Uniformed Services University of Health Sciences, Bethesda, MA
Objective
* Examine the prescribing patterns for psychotropic medications of military health system beneficiaries diagnosed with cancer overall, and for beneficiaries with breast, prostate, lung, head and neck, and colorectal cancer, and melanoma.
Methods
Population: All unique Military Health System (MHS) beneficiaries ages residing in the United States were included if they accessed the healthcare system within the Fiscal Year (FY) and had a diagnosis of prostate, breast, lung or head and neck cancer. Beneficiaries were excluded if they resided overseas for the FY.
Data: Demographic, healthcare cost and utilization, and filled prescription data were obtained from the MHS’s Master Data Repository for healthcare claims paid by TRICARE.
Timeframe FY2007-FY2014, inclusive
Cancer Diagnosis
* Based upon primary ICD-9 associated with the healthcare claim, using the Agency for Healthcare Research and Quality's (AHRQ) Clinical Classification Software (CCS) and the National Cancer Institute’s SEER cancer site definitions.
* A beneficiary was considered to have a cancer if there were a minimum of: a) 2 outpatient visits within a FY with the same ICD-9; and/or b) 1 inpatient admission for a given ICD-9.
* Statistics represent unique beneficiaries per FY and cancer site. A beneficiary could have a diagnosis for more than one cancer site.
Prescription Drugs
Therapeutic pharmaceutical classifications and costs were obtained for all filled prescriptions per unique beneficiary and FY. Filled prescriptions were assigned across cancer sites for beneficiaries with multiple cancers.
Selected Therapeutic Classes: antidepressants, antipsychotics, barbituates (anxiolytics, sedatives), benzodiazepines (anxiolytic, sedative-hypnotics), anxiolytics, sedatives, hypnotics, and antimanic agents.
System of Care
Beneficiaries were uniquely assigned to a system of care for analysis. Direct Care refers to care received only in the military health system. Civilian care refers to care received only in the civilian system. Beneficiaries who used both direct and civilian care were assigned to both systems of care.
Summary of Findings
* Prevalence rates rates for all cancers and by cancer site have remained relatively stable from FY2007 to FY2014.
* Average annual number of psychotropic medication prescriptions per person for all cancer sites have remained relatively stable over time.
* Among the selected classes of psychotropic medications, antidepressants are most commonly prescribed.
* Lung and head and neck cancer patients fill the most prescriptions per person.
* Patients receiving care in civilian care fill, on average, 58% more prescriptions than patients in military care.
Conclusions
* Overall, system of care differences in prescribing patterns may be due to:
Differences in patient acuity, as more acutely ill patients are treated in civilian care. Higher use of psychotropic medications is associated with co-morbid disease and end-of-life care,1 though use of antidepressants appears unrelated to cancer stage or survival outcomes.2
Differences in case mix. Direct care providers treat a larger percentage of men with prostate cancer and a lower percentage of women with breast cancer. Higher rates of antidepressant prescriptions are associated with breast cancer patients, while those with prostate cancer are least likely to be prescribed antidepressants, sedatives, or hypnotics.3
Differences in exposure to pharmaceutical marketing, most notably for the promotion of antidepressants.4 Compared to military providers, civilian providers are more likely to have their prescribing patterns influenced by encounters with pharmaceutical marketing; such marketing is restricted in military care settings.
* Higher rates of benzodiazepines and anxiolytics/sedatives/hypnotics prescribed to lung and head and neck cancer patients most likely reflect higher use of these drugs in populations at risk for psychological disorders associated with substance use or abuse.
* Despite numerous limitations using medical claims data, our findings indicate that prescribing patterns for psychotropic medications have remained relatively stable in the past 8 years among MHS beneficiaries diagnosed with cancer.
References
1 Pearson SA, Abrahamowicz M, Srasuebkul P, et al. Pharmacoepidemiol Drug Saf Jun;24(6):600-9.
2 Janberidze E, Hjermstad MJ, Brunelli C, et al. Psychooncology Oct;23(10):
3 Zuckerman IH, Davidoff AJ, Erten MZ, et al. Support Care Cancer Aug;22(8):
4 Epstein AJ, Asch DA, Barry CL. LDI Issue Brief Jan;18(3):1-4.
Disclaimer: The opinions or assertions herein are those of the authors and do not necessarily reflect the view of the U.S. Department of Defense or the U.S. Government.
Conflicts of Interest: None