Treatment patterns and health care resource utilization in a 1-year observational cohort study of outpatients with schizophrenia at risk of nonadherence treated with long-acting injectable antipsychotics

Abstract

Purpose: To describe (1) the clinical profiles and the patterns of use of long-acting injectable (LAI) antipsychotics in patients with schizophrenia at risk of nonadherence with oral antipsychotics, and in those who started treatment with LAI antipsychotics, (2) health care resource utilization and associated costs.

Patients and methods: A total of 597 outpatients with schizophrenia at risk of nonadherence, according to the psychiatrist's clinical judgment, were recruited at 59 centers in a noninterventional prospective observational study of 1-year follow-up when their treatment was modified. In a post hoc analysis, the profiles of patients starting LAI or continuing with oral antipsychotics were described, and descriptive analyses of treatments, health resource utilization, and direct costs were performed in those who started an LAI antipsychotic.

Results: Therapy modifications involved the antipsychotic medications in 84.8% of patients, mostly because of insufficient efficacy of prior regimen. Ninety-two (15.4%) patients started an LAI antipsychotic at recruitment. Of these, only 13 (14.1%) were prescribed with first-generation antipsychotics. During 1 year, 16.3% of patients who started and 14.9% of patients who did not start an LAI antipsychotic at recruitment relapsed, contrasting with the 20.9% who had been hospitalized only within the prior 6 months. After 1 year, 74.3% of patients who started an LAI antipsychotic continued concomitant treatment with oral antipsychotics. The mean (median) total direct health care cost per patient per month during the study year among the patients starting any LAI antipsychotic at baseline was €1,407 (€897.7). Medication costs (including oral and LAI antipsychotics and concomitant medication) represented almost 44%, whereas nonmedication costs accounted for more than 55% of the mean total direct health care costs.

Conclusion: LAI antipsychotics were infrequently prescribed in spite of a psychiatrist-perceived risk of nonadherence to oral antipsychotics. Mean medication costs were lower than nonmedication costs.

Keywords: depot preparations; health care costs; medication adherence.

Figure 1

Patients’ disposition throughout the study. Notes: Total patients starting LAI AP during the study: 114 (93 ris, 9 flu, 12 zucl). ^aOne patient left riseperidone LAI to start fluphenazine LAI; ^bone patient left riseperidone LAI to start Zuclopenthixol LAI and one patient left zuclopenthixol LAI to start risperidone LAI. Abbreviations: AP, antipsychotics; flu, fluphenazine; ris, risperidone; zucl, zuclopenthixol.

Figure 2

Kaplan–Meier description of the proportion of the sample surviving without relapse during follow-up (n = 597).

Figure 3

Distribution of the doses of LAI risperidone at each study assessment among patients treated with this medication. Abbreviation: LAI, long-acting injectable.

Figure 4

Kaplan–Meier description of the proportion of patients receiving concomitant oral antipsychotics together with LAI antipsychotics, regardless of whether the LAI antipsychotic was started at baseline or during the study. Abbreviation: LAI, long-acting injectable.

Figure 5

Pie chart showing the breakdown of direct health care costs throughout the study year incurred by patients who started a long-acting injectable antipsychotic at recruitment (n = 92).