All-cause hospitalization and associated costs in patients with schizophrenia or bipolar disorder initiating long-acting injectable antipsychotics

Abstract

Objective: To compare all-cause hospitalization and associated costs among patients with schizophrenia or bipolar disorder (BD) treated with long-acting injectable antipsychotics (LAIs).

Methods: The Truven MarketScan Medicaid claims database was used to identify patients with schizophrenia; MarketScan Medicaid and commercial claims databases were used to identify BD. Adult patients with ≥1 LAI claim from January 1, 2013–June 30, 2014 (ID period) were identified. The first day of LAI initiation was the index date; patients were followed for ≥1 year. Logistic and general linear regression models were used to estimate the risk of hospitalization and associated costs.

Results: Adjusted analyses showed that, in the schizophrenia cohort, risks of hospitalization were statistically significantly higher in the haloperidol [OR (95% CI) = 1.51 (1.05–2.16); HR (95% CI) = 1.35 (1.05–1.73)] and risperidone [OR (95% CI) = 1.58 (1.07–2.33); HR (95% CI) = 1.33 (1.01–1.74)] cohorts than in the aripiprazole once monthly extended release (AOM 400) cohort. Similarly, in patients with BD, risks of hospitalization were significantly higher in haloperidol [OR (95% CI) = 1.49 (1.01–2.19); HR (95% CI) = 1.33 (1.03–1.73)] and risperidone [OR (95% CI) = 1.78 (1.19–2.66); HR (95% CI) = 1.33 (1.01–1.75)] than in AOM400. No statistically significant differences in hospitalization costs were observed in either disease group.

Conclusions: Although the study results may be subject to confounding variables that are not contained in claims databases, such as disease severity, it appears that AOM400 may be more effective than haloperidol and risperidone LAIs among patients with schizophrenia or BD.

Keywords:

• Long-acting injectables
• schizophrenia
• bipolar disorder
• hospitalization
• cost

Transparency

Declaration of funding

This research was supported by Otsuka Pharmaceutical Development and Commercialization Inc. and Lundbeck.

Declaration of financial/other relationships

M. Greene is an employee of Otsuka Pharmaceutical Development and Commercialization Inc., Princeton, NJ. T. Yan, M.S. Broder, and E. Chang are employees of Partnership for Health Analytic Research, LLC, Beverly Hills, CA. A. Hartry and M. Touya are employees of Lundbeck, Deerfield, IL. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Peer reviewers on this manuscript have received an honorarium from CMRO for their review work, but have no other relevant financial relationships to disclose.

Acknowledgments

No assistance in the preparation of this article is to be declared.

Previous presentations

International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 22^nd Annual International Meeting, May 2017; Health Technology Assessment International (HTAi) 2017 Annual Meeting, June 17–21, 2017.