Real-World Treatment Patterns and Healthcare Resource Utilization in Tardive Dyskinesia: Claims Analysis of Individuals Treated with Benztropine or a VMAT2 Inhibitor

Background Tardive dyskinesia (TD) is a persistent hyperkinetic movement disorder associated with the use of dopamine receptor antagonists. Despite vesicular monoamine transporter type 2 (VMAT2) inhibitors being recommended as first-line treatment, benztropine is sometimes prescribed off-label and may aggravate TD symptoms. Objective To compare US healthcare resource utilization (HCRU) between benztropine-treated and nontreated and between benztropine-treated and VMAT2 inhibitor–treated individuals with TD. Methods Retrospective claims analyses included individuals with TD with ≥1 year of continuous insurance coverage before and after treatment initiation (index date). Part 1 (MarketScan® database [July 2012–Sept. 2021]) included adults with first TD diagnosis from July 2013 to September 2020. Individuals with benztropine initiated on/after first TD diagnosis were matched exactly by age, sex, and the Quan adaptation of the Charlson Comorbidity Index to nontreated individuals. Part 2 (MarketScan® [Jan. 2016–Sept. 2023]; Medicaid [Jan. 2018–Dec. 2022]) included adults with TD diagnosis (Jan. 2017–Sept. 2022) ≤1 year before benztropine or VMAT2 inhibitor initiation. VMAT2 inhibitor–treated and benztropine-treated cohorts underwent 1:1 propensity score matching. All-cause HCRU was compared between matched cohorts. Results In part 1, 92 benztropine-treated individuals with TD were matched to 92 nontreated individuals with TD (mean age, 47.7 years; 77.2% female). Post-index, mean (SD) annual number of emergency department visits was significantly higher for benztropine-treated individuals than nontreated individuals (1.0 [1.8] vs 0.5 [1.0]; P = .0232). In part 2, post-index, significantly higher proportions of individuals in the benztropine-treated cohort (n = 272) vs the matched VMAT2 inhibitor–treated cohort (n = 272) had ≥1 inpatient visit (36.8% vs 22.1%; P < .001). Mean (SD) numbers of inpatient (0.9 [2.2] vs 0.5 [1.2]; P = .004) and emergency department visits (2.6 [6.0] vs 1.6 [4.0]; P = .024) were higher in the benztropine-treated vs VMAT2 inhibitor–treated cohorts, respectively. Conclusion Treatment of TD with benztropine was associated with higher all-cause HCRU than no treatment or VMAT2 inhibitor treatment.