Early initiation of long-acting injectable antipsychotic treatment is associated with lower hospitalization rates and healthcare costs in patients with schizophrenia: real-world evidence from US claims data

Abstract

Objective: Early initiation of antipsychotic treatment in schizophrenia is associated with improved outcomes. This study aimed to determine if initiation of long-acting injectable (LAI) antipsychotic treatment early in a new schizophrenia episode is associated with lower hospitalization rates and healthcare costs in a real-world setting.

Methods: This retrospective (January 1, 2007–June 30, 2016) cohort analysis used claims from Truven Health Analytics MarketScan Commercial, Medicaid, and Medicare Supplemental databases. In adults ≥18 years with a new episode of schizophrenia, two mutually exclusive cohorts were identified based on time from first recorded schizophrenia diagnosis date to first date of LAI initiation (index date): ≤1 year (early initiators) and >1 year (late initiators). Logistic and general linear regression models were performed to estimate adjusted hospitalization rate and healthcare costs in a 1-year follow-up, controlling patient demographic and clinical characteristics, insurance type, baseline all-cause hospitalizations and ED visits, and baseline psychiatric medication use.

Results: Of the subjects, 32% (n = 1388) initiated treatment early and 68% (n = 2978) initiated treatment later. In risk-adjusted models, all-cause hospitalization rates were 22.2% (95% CI = 19.9–24.6%) in early initiators and 26.9% (95% CI = 25.2–28.7%) in late initiators (p = .002). Of early initiators, 14.1% (95% CI = 12.3–16.1%) had a psychiatric hospitalization vs 19.2% (95% CI = 17.7–20.8%) of late initiators (p < .001). Adjusted psychiatric healthcare costs were significantly lower in early initiators compared with late initiators [mean (95% CI) = $21,545 (20,355–22,734) vs $24,132 (23,330–24,933)] (p < .001).

Conclusions: LAI initiation within 1 year of a new schizophrenia episode led to lower hospitalization rates and healthcare costs compared with LAI initiation more than 1 year after a new episode.

Keywords:

• Long-acting injectable antipsychotics
• Schizophrenia
• Healthcare utilization
• Healthcare cost

Transparency

Declaration of funding

Funding for the study was received from Otsuka Pharmaceutical Development and Commercialization, Inc. and Lundbeck.

Declaration of financial/other relationships

Greene is an employee of Otsuka Pharmaceutical Development and Commercialization, Inc. Hartry is an employee of Lundbeck. Broder, Chang, Munday, and Yan are employees of PHAR, LLC, which was paid by Otsuka and Lundbeck to perform the research described in this manuscript. 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.