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Treatment Patterns, Healthcare Resource Utilization and Costs Among Schizophrenia Patients Treated with Long-Acting Injectable Versus Oral Antipsychotics

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Abstract

Introduction

Long-acting injectable (LAI) antipsychotic use may reduce healthcare resource utilization compared with oral antipsychotic use by improving adherence and reducing dosing frequency. Our goal was to examine treatment patterns, healthcare utilization, and costs among recently diagnosed schizophrenia patients receiving oral versus LAI antipsychotics.

Methods

The MarketScan Multi-state Medicaid database was used to identify schizophrenia patients aged ≥ 18 years who received an LAI or oral antipsychotic between January 1, 2011 and December 31, 2014. Primary outcomes included treatment patterns such as adherence (measured as proportion of days covered-PDC), persistence, discontinuation, switching, and healthcare resource utilization and costs. Propensity score matching (PSM) was used to control for differences in baseline characteristics between the cohorts. Outcomes were assessed over a 12-month post-index period and compared between treatment cohorts.

Results

After PSM, 2302 patients were included in each of the LAI and oral antipsychotics cohorts. There were no differences in PDC or therapy switching between the two cohorts. Compared with the oral cohort, patients receiving LAIs had lower discontinuation rates (46.1 vs. 61.6%, p < 0.001), fewer inpatient admissions (0.5 vs. 0.9, p < 0.001), hospital days (3.9 vs. 6.5, p < 0.001), and ER visits (2.4 vs. 2.9, p = 0.007), and a higher number of prescription fills (29.5 vs. 25.3, p < 0.001). Patients prescribed LAIs had lower monthly inpatient ($US4007 vs. 8769, p < 0.001) and ER visits costs ($682 vs. 891, p < 0.001) but higher monthly medication costs ($10,713 vs. $655, p < 0.001) compared with the oral cohort over the 12-month post-index period. Overall, both cohorts had similar total medical costs (LAI vs. oral: $24,988 vs. 23,887, p = 0.354) during the follow-up period.

Conclusion

Patients receiving LAIs were more likely to remain on medication compared with the oral group, which may account for reduced inpatient admissions. Hospitalization cost reductions offset the higher costs of LAI medications, resulting in no increase in total healthcare costs relative to oral antipsychotic use.

Funding

Alkermes Inc.

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Acknowledgements

Funding

This study and the accompanying article processing charges were funded by Alkermes Inc. All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analyses.

Medical Writing and/or Editorial Assistance

Editorial support was provided by Michael Moriarty of STATinMED Research.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Prior Presentations

This study was presented at the following conferences: the US Psychiatric and Mental Health Congress (USPC) New Orleans, LA, USA (Sep 16–19, 2017) and Academy Managed Care Pharmacy (AMCP) Nexus, Dallas, TX, USA (Oct 16–19, 2017).

Disclosure Statement

Ankit Shah is a full-time employee and a minor shareholder of Alkermes, Inc. Mugdha Gore was employed at Alkermes, Inc. when the study was conducted. Mugdha Gore is currently the President & CEO of Avalon Health Solutions, Inc and Founder of Samsara Healthcare Inc. Lin **e is a full-time employee of STATinMED Research which is a paid consultant to Alkermes, Inc. Furaha Kariburyo is a full-time employee of STATinMED Research which is a paid consultant to Alkermes, Inc. Qisu Zhang is a full-time employee of STATinMED Research which is a paid consultant to Alkermes, Inc.

Compliance with Ethics Guidelines

This article is based on retrospective administrative claims data and does not contain any studies with human participants or animals performed by any of the authors

Data Availability

The datasets generated and/or analyzed during the current study are not publicly available due to a data licensing agreement with Truven Health Analytics.

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Authors and Affiliations

  1. Alkermes, Inc, Waltham, MA, USA

    Ankit Shah & Mugdha Gore

  2. STATinMED Research, Ann Arbor, MI, USA

    Lin **e, Furaha Kariburyo & Qisu Zhang

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  1. Ankit Shah
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Correspondence to Ankit Shah.

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Shah, A., **e, L., Kariburyo, F. et al. Treatment Patterns, Healthcare Resource Utilization and Costs Among Schizophrenia Patients Treated with Long-Acting Injectable Versus Oral Antipsychotics. Adv Ther 35, 1994–2014 (2018). https://doi.org/10.1007/s12325-018-0786-x

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