Background

Continuous antipsychotic therapy is recommended as part of long-term maintenance treatment of schizophrenia, and gaps in antipsychotic treatment have been associated with increased risks of relapse and rehospitalization. Because the use of long-acting injectable (LAI) antipsychotics may reduce the likelihood of undetected medication gaps, initiating an LAI medication may affect resource utilization and costs. The LAI aripiprazole lauroxil (AL) was approved in the United States (US) in 2015 for the treatment of schizophrenia in adults.

Objective

The objective of this retrospective observational cohort study was to examine treatment patterns, resource utilization, and costs following initiation of AL for the treatment of schizophrenia in adults.

Methods

A retrospective analysis of Medicaid claims data identified a cohort of patients (N = 485) starting AL shortly after Food and Drug Administration approval in October 2015. Treatment patterns, resource utilization, and costs were compared 6 months before and after treatment initiation. Subgroup analyses were conducted based on the type of antipsychotic (LAI, oral, or none) received before initiation of AL.

Results

Over 6 months of follow-up, patients received an average of 4.6 injections out of a maximum of six (77%). After initiating AL, all-cause inpatient admissions decreased by 22.4%; other significant reductions were observed in mental health–related admissions and emergency room (ER) visits. All-cause inpatient costs decreased by an average of US$2836 per patient (p < 0.05) in the 6-month post-AL period, whereas outpatient pharmacy costs increased by US$4121 (p < 0.05), resulting in no significant difference in overall costs between the pre- and post-AL periods. The subgroup of patients who had been prescribed an oral antipsychotic before starting AL had significant reductions in proportion of patients with inpatient and ER visits and costs, but also reported a significant increase in pharmacy costs.

Conclusions

AL was associated with a significant reduction in inpatient costs and an increase in outpatient pharmacy costs, resulting in no changes in total healthcare costs over 6 months. The adherence rate and reductions in inpatient use may indicate the potential for greater clinical stability among patients initiated on AL compared with their previous treatment.

中文翻译：

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使用长效注射剂 (LAI) 阿立哌唑月桂醇治疗精神分裂症 6 个月后的实际结果和成本

背景

建议将持续抗精神病药物治疗作为精神分裂症长期维持治疗的一部分，而抗精神病药物治疗的差距与复发和再住院风险的增加有关。因为使用长效可注射 (LAI) 抗精神病药可能会降低未发现药物缺口的可能性，所以启动 LAI 药物可能会影响资源利用率和成本。LAI 阿立哌唑月桂醇 (AL) 于 2015 年在美国 (US) 获批用于治疗成人精神分裂症。

客观的

这项回顾性观察性队列研究的目的是检查开始 AL 治疗成人精神分裂症后的治疗模式、资源利用和成本。

方法

对 Medicaid 索赔数据的回顾性分析确定了 2015 年 10 月食品和药物管理局批准后不久开始 AL 的一组患者 ( N = 485)。比较了治疗开始前后 6 个月的治疗模式、资源利用和成本。根据 AL 开始前接受的抗精神病药物类型（LAI、口服或无）进行亚组分析。

结果

在 6 个月的随访中，患者最多接受 4.6 次注射（77%）。启动 AL 后，全因住院人数减少了 22.4%；在与心理健康相关的入院和急诊室 (ER) 就诊中观察到其他显着减少。在 AL 后 6 个月内，每位患者的全因住院费用平均减少了 2836 美元（p < 0.05），而门诊药房费用增加了 4121 美元（p< 0.05)，导致 AL 前后期间的总成本没有显着差异。在开始 AL 之前已开具口服抗精神病药的患者亚组住院和急诊就诊的患者比例和费用显着降低，但药房费用也显着增加。

结论

AL 与住院费用的显着降低和门诊药房费用的增加有关，导致 6 个月内总医疗费用没有变化。依从率和住院患者使用的减少可能表明，与之前的治疗相比，开始接受 AL 的患者临床稳定性可能更高。