The Clinical and Economic Burden of Tardive Dyskinesia in Israel: Real-World Data Analysis

Abstract

Purpose/background: Tardive dyskinesia (TD) is a hyperkinetic movement disorder caused by exposure to dopamine-receptor blockers. Data on TD burden in Israel are scarce. This analysis assesses the clinical and economic burden of TD in Israeli patients.

Methods/procedures: This retrospective analysis used a national health plan database (Maccabi Healthcare Services), representing 25% of the Israeli population. The study included adults alive at index date with an International Classification of Diseases, Ninth Revision, Clinical Modification TD diagnosis before 2018 and more than or equal to 1-year enrollment before diagnosis. Tardive dyskinesia patients were matched to non-TD patients (1:3) by underlying psychiatric condition, birth year, and sex. Treatment patterns and 2018 annual health care resource utilization and costs were assessed.

Findings/results: Of 454 TD patients alive between 2013 and 2018, 333 alive on January 1, 2018, were matched to 999 non-TD patients. At baseline, TD patients had lower socioeconomic status and higher proportion of chronic kidney disease and antipsychotic medication use; all analyses were adjusted accordingly. Tardive dyskinesia patients had significantly more visits to general physicians, neurologists, psychiatrists, physiotherapists, and emergency departments versus non-TD patients (all P < 0.05). Tardive dyskinesia patients also had significantly longer hospital stays than non-TD patients ( P = 0.003). Total healthcare and medication costs per patient were significantly higher in the TD versus non-TD population (US $11,079 vs US $7145, P = 0.018).

Implications/conclusions: Israeli TD patients have higher clinical and economic burden than non-TD patients. Understanding real-world health care resource utilization and costs allows clinicians and decision makers to quantify TD burden and prioritize resources for TD patients' treatment.

FIGURE 1

Patient disposition.

FIGURE 2

Diagnosis and medication use in the treatment patterns population (n = 454). GP, general physician. The treatment patterns population included all patients with a TD diagnosis who were alive between 2013 and 2018.

FIGURE 3

Estimated mean number of visits to health care practitioners in patients with and without TD in 2018. *P < 0.05. ***P < 0.0001. Estimated means and significance levels were calculated using generalized linear models with negative binomial with log link distribution. The adjusted model included socioeconomic status, chronic kidney disease at baseline, and antipsychotic medication group.

FIGURE 4

Health care and medication costs (2018 US dollars). ^aAnnual costs included the costs from all outpatient clinic visits, hospitalizations, ED visits, and medication purchases during 2018. **P = 0.018. ***P < 0.0001. Significances and estimated means were calculated using generalized linear models with γ distribution with log link distribution. The adjusted model included socioeconomic status, chronic kidney disease at baseline, and antipsychotic medication group.