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.
Acknowledgment
The authors thank Jesús Villoria from Medicxact who provided medical writing services for drafting and submitting this manuscript.
Disclosure
Miguel Bernardo has participated as a speaker and member of the advisory boards of, and has received grant/research support and honoraria from, Bristol-Myers-Squibb, Eli Lilly, Janssen-Cilag, Mylan, Organon, and Pfizer. Luis San has received grant/research support, received honoraria from, and participated as a speaker and is on the advisory boards of AstraZeneca, Bristol-Myers-Squib, Eli Lilly, Pfizer, Janssen, and Wyeth. José M Olivares has received honoraria from Janssen-Cilag, Lundbeck, AstraZeneca, Eli Lilly, Bristol-Myers-Squibb, Sanofi-Aventis, and Pfizer and has participated in advisory boards organized by Eli Lilly, Janssen-Cilag, and AstraZeneca. Antonio Ciudad, María Álvarez, Tatiana Dilla, Pepa Polavieja, and Inmaculada Gilaberte are full-time employees of Lilly, SA, an affiliate of Eli Lilly and Company.