Disparities in Tardive Dyskinesia Diagnosis and Treatment Among the US Medicare Population
Author(s)
Yvonne Yang, MD, PhD1, Justin Nedzesky, PharmD, MS2, Samantha E. Clark, PhD, MHS3, Frankie Berger, MSc2, Eric S. Zuk, MBA3, Avery Mohan, BA3, Zachary Marcum, PharmD, PhD3, Vanessa Fisher, MPA2, Michael Serbin, MBA, MS, PharmD2, Jamie Hamill, DNP, APRN, PMHNP-BC2, Dawn Vanderhoef, PhD, DNP, PMHNP, FAANP2, Morgan Bron, PharmD, MS2, Adys Mendizabal, MD, MS1.
1University of California, Los Angeles (UCLA), Los Angeles, CA, USA, 2Neurocrine Biosciences, Inc, San Diego, CA, USA, 3Medicus Economics, Milton, MA, USA.
1University of California, Los Angeles (UCLA), Los Angeles, CA, USA, 2Neurocrine Biosciences, Inc, San Diego, CA, USA, 3Medicus Economics, Milton, MA, USA.
OBJECTIVES: Tardive dyskinesia (TD) is a chronic movement disorder associated with prolonged exposure to antipsychotics. Disadvantaged populations are often at elevated risk of developing TD and also face higher rates of antipsychotic prescribing. This study aims to characterize disparities in TD diagnosis and treatment by identifying high-risk populations across a broad range of health equity measures.
METHODS: In a retrospective cohort study of Medicare claims (2017-2021), we identified predictors of TD diagnosis (ICD-10-D G24.01) among chronic antipsychotic users (≥180 days of use within 365 days of first fill). Among patients diagnosed with TD, a nested analysis was performed evaluating likelihood of appropriate treatment, defined as initiation of an FDA-indicated VMAT2 inhibitor ≤90 days on/after diagnosis. Demographic and clinical factors associated with TD diagnosis and treatment were identified using separately specified logistic regression models to estimate predicted probabilities and average marginal effects via recycled predictions. Bootstrap resampling generated standard errors and 95% confidence intervals (CIs).
RESULTS: Among 16,830 incident TD cases, 7% (n=1,218) were appropriately treated. Risk of TD was 15% higher (95% CI: 10%-20%) in Black versus White patients and 23% higher (95% CI: 19%-28%) in dual-eligible Medicare/Medicaid versus Medicare-only patients. Conversely, Latino versus White patients were 24% less likely (95% CI: 19%-29%) to be diagnosed with TD. Patients with incident TD treated in long-term care (LTC) settings were 73% (95% CI: 53%-84%) less likely to receive appropriate TD treatment versus those in the community mental health care setting; dual-eligible patients were 17% (95% CI: 2%-34%) more likely to receive appropriate treatment versus Medicare-only.
CONCLUSIONS: Black and dual-eligible patients were significantly more likely to be diagnosed with TD, and Latino patients significantly less likely. Subsequent likelihood of appropriate TD treatment was lower among LTC patients and higher among dual-eligibles. Improvements in TD screening and treatment education may help reduce TD burden in vulnerable groups.
METHODS: In a retrospective cohort study of Medicare claims (2017-2021), we identified predictors of TD diagnosis (ICD-10-D G24.01) among chronic antipsychotic users (≥180 days of use within 365 days of first fill). Among patients diagnosed with TD, a nested analysis was performed evaluating likelihood of appropriate treatment, defined as initiation of an FDA-indicated VMAT2 inhibitor ≤90 days on/after diagnosis. Demographic and clinical factors associated with TD diagnosis and treatment were identified using separately specified logistic regression models to estimate predicted probabilities and average marginal effects via recycled predictions. Bootstrap resampling generated standard errors and 95% confidence intervals (CIs).
RESULTS: Among 16,830 incident TD cases, 7% (n=1,218) were appropriately treated. Risk of TD was 15% higher (95% CI: 10%-20%) in Black versus White patients and 23% higher (95% CI: 19%-28%) in dual-eligible Medicare/Medicaid versus Medicare-only patients. Conversely, Latino versus White patients were 24% less likely (95% CI: 19%-29%) to be diagnosed with TD. Patients with incident TD treated in long-term care (LTC) settings were 73% (95% CI: 53%-84%) less likely to receive appropriate TD treatment versus those in the community mental health care setting; dual-eligible patients were 17% (95% CI: 2%-34%) more likely to receive appropriate treatment versus Medicare-only.
CONCLUSIONS: Black and dual-eligible patients were significantly more likely to be diagnosed with TD, and Latino patients significantly less likely. Subsequent likelihood of appropriate TD treatment was lower among LTC patients and higher among dual-eligibles. Improvements in TD screening and treatment education may help reduce TD burden in vulnerable groups.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HSD59
Topic
Health Service Delivery & Process of Care
Disease
SDC: Mental Health (including addition), SDC: Neurological Disorders