Impact on healthcare resource usage and costs among Medicaid-insured schizophrenia patients after initiation of treatment with long-acting injectable antipsychotics

Abstract

Objective:

This study compared healthcare resource usage and costs before and after initiating LAI antipsychotics among Medicaid-insured schizophrenia patients.

Methods:

Schizophrenia patients ≥13 years of age initiating LAI antipsychotics were identified from the Thomson Reuters MarketScan® Research Medicaid database between 7/1/2005 and 6/30/2010. Patients were required to have 6 months of continuous medical/prescription drug coverage prior to LAI initiation (baseline period) and during a variable follow-up period. Annualized healthcare resource usage and costs for the baseline and follow-up periods were determined and compared.

Results:

Among 5694 eligible patients, 55% were male and 45% were female, and the majority of the population was between the ages of 18–55 (86%). The study population had low general comorbidity, as assessed by the Charlson Comorbidity Index (CCI). Diabetes (17%) and chronic pulmonary disease (14%) were the most prevalent comorbidities. In comparison to the baseline period, during the follow-up period (mean duration = 25.7 months) the mean number of hospitalizations, all cause (1.52 ± 2.41 vs 0.70 ± 1.61, p < 0.001) and schizophrenia-related (1.21 ± 2.04 vs 0.57 ± 1.41, p < 0.001) declined as well as hospital lengths of stay (all cause: 14.77 ± 28.61 vs 5.75 ± 16.26 days, p < 0.001; schizophrenia-related: 12.39 ± 25.86 vs 4.67 ± 13.54 days, p < 0.001). As a result, annualized hospital payments were much lower (all cause: $16,249 ± $36,404 vs $7380 ± $21,087, p < 0.001; schizophrenia-related: $13,388 ± $31,614 vs $5645 ± $15,767, p < 0.001).

Limitations:

This study attempted to minimize the impact of differences in patient characteristics by having patients serve as their own controls in the before vs after comparison, however one still may not be able to account for all confounders in this non-randomized study population.

Conclusion:

For patients with schizophrenia who initiate LAI antipsychotic therapy, there is an improvement in disease management based on fewer hospitalizations for relapses, which is also associated with a marked reduction in healthcare costs.

Key words::

• Schizophrenia
• Long-acting injectable antipsychotics
• Healthcare resource usage
• Healthcare costs

Transparency

Declaration of funding

This research and preparation of this manuscript were supported by Otsuka America Pharmaceutical, Inc. and H. Lundbeck A/S.

Declaration of financial/other relationships

RB is on the speakers bureau for Astra Zeneca, Forest, Novartis, and Sunovion. SO, DZ, and GL are employees of Otsuka America Pharmaceutical, Inc. JL is an employee of Novosys Health, which has received financial funds from Otsuka America Pharmaceutical, Inc. in connection with conducting this study and development of this manuscript. CK is a paid consultant for Otsuka America Pharmaceutical, Inc.

Acknowledgments

We would like to acknowledge Melissa Lingohr-Smith from Novosys Health in the editorial support and review of this manuscript.