ObjectiveTo compare the risk of hospitalization for adult Medicaid beneficiaries with bipolar I disorder (BPD-I) when treated with lurasidone compared to other atypical antipsychotics (AAPs) as monotherapy.

MethodsUsing IBM MarketScan Multi-State Medicaid Claims database, a retrospective cohort study was conducted on adult BPD-I patients who initiated an AAP (index date) between January 1, 2014 and June 30, 2019. Patients were required to be continuously enrolled during the 12-month pre- and 24-month post-index date. Marginal structural models were performed to estimate the risk of hospitalization (all-cause, BPD-I-related, and psychiatric-related) associated with each AAP and the average length of stay.

ResultsThe analysis included 8262 adult BPD-I patients, of whom AAP use was divided between lurasidone (14%), aripiprazole (17%), olanzapine (8%), quetiapine (29%), risperidone (10%), no/minimal (1%) or other (21%) during each month of post-index period. The adjusted odds ratios (aORs) for all-cause hospitalization were significantly higher for olanzapine (aOR=1.60, 95% CI=1.09–2.10) and quetiapine (aOR=1.54, 95% CI=1.18–1.89), compared to lurasidone. The aORs for BPD-I-related hospitalization were significantly higher for quetiapine (aOR=1.57, 95% CI=1.10–2.04) and risperidone (aOR=1.80, 95% CI=1.04–2.56) compared to lurasidone. The average length of hospital stay was more than twice as high for quetiapine compared to lurasidone (aRR=2.12, 95% CI=1.32–2.92). The risk of psychiatric-related hospitalization was numerically lower for lurasidone compared to all other AAPs.

ConclusionOver a 24-month follow-up period, lurasidone-treated adult BPD-1 patients had significantly lower risk of all-cause hospitalization than those treated with olanzapine and quetiapine, lower risk of BPD-I-related hospitalization than quetiapine and risperidone, and fewer hospital days than quetiapine in a Medicaid population.