The impact on schizophrenia-related hospital utilization and costs of switching to long-acting risperidone injections in Sweden
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To estimate changes in resource usage, hospitalization rates, and costs in actual practice in Sweden for schizophrenia patients after switching to long-acting injectable risperidone (Risperdal Consta).
A retrospective chart review within-subject mirror-image study using actual practice chart review data was used to compare annual hospital bed-days and annual hospital episodes for adults with schizophrenia or schizoaffective disorder before and after switching to Risperdal Consta in the period 1 January 2003 to 30 June 2005. Secondary endpoints included mean length of hospital stay per episode, the cost of hospitalization, and the cost of antipsychotic treatment. The base case analytical approach allocated all hospital episodes overlapping the switch date entirely to pre-switch treatment. In order to investigate the impact of inpatient care ongoing at the time of the switch, the change in bed-days per year was also estimated using an alternative analytical approach inspired by economic modelling.
One-hundred sixty-four patients were enrolled at nine geographically diverse sites. The switch to Risperdal Consta was associated with a significant reduction in mean annual days in hospital from 39 to 21 days per year (45%), which was linked to a significant reduction in the number of hospitalizations from 0.86 to 0.63 per year (27%). The alternative “modelling-inspired” estimate of the reduction in mean annual days in hospital was also 27%.
A naturalistic mirror-image study found that switching to long-acting injectable risperidone led to sizeable reductions in inpatient resource use. These results coincide with the findings of other international studies.
KeywordsSchizophrenia Health resources Mirror-image study design Risperidone
The authors wish to thank Maria Kastenholm for monitoring the study; Christian Asseburg at The Swedish Institute for Health Economics for invaluable assistance; Janssen-Cilag, Sweden for finance and data collection; and Dorin Borota, Cecilia Brain, Ludvig Elfwén, Kalle Forsman, Martin Fransson, Iris Förstberg, Ola Gefvert, Lars Gidlund, Siv Gustavsson, Per Hagström, Marie Hansson, Yvonne Holm, Lotta Ibstedt Farde, Magnus Malm, Deanne Mannelid, Hannele Mered, Urban Norén, Britt-Marie Hansson, Maivor Olsson, Hans Olsson, Natalja Shulman, Catharina Sigalin, Olof Strandell, and Gunnel Stråmo for participation at the sites. We also express our gratitude to the editor and to two anonymous reviewers for invaluable comments.
- 1.Regier, D.A., Narrow, W.E., Rae, D.S., Manderscheid, R.W., Locke, B.Z., Goodwin, F.K.: The de facto mental and addictive disorders service system. Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services. Arch. Gen. Psychiatry 50, 85–94 (1993)Google Scholar
- 3.Fuller, M., Shermock, K., Secic, M., Engelhart, L., Vallow, S., Flanders, S.: Hospitalization and resource utilization in schizophrenia following initiation of risperidone long-acting injection in the Veterans Affairs Healthcare System (VISN 10). Presented at the Collegium Internationale Neuro-psychopharmacolegium 25th Biennial Congress, Chicago, Illinois, 9–13 July 2006Google Scholar
- 4.Eriksson, L., Almqvist, A., Mehnert, A., Ingham, M., Eriksson, B.: Reduction in need for institutional care in chronic schizophrenia subjects switched to long-acting risperidone. Presented at the 42nd Annual Meeting of the American College of Neuropsychopharmacology, San Juan, Puerto Rico, 7–11 December 2003Google Scholar
- 5.Eriksson, L., Almqvist, A., Mehnert, A., Ingham, M., Eriksson, B.: Treatment with long acting risperidone significantly reduces the need for institutional psychiatric care regardless of previous treatment. Presented at the 45th Annual and 4th Mediterranean Meeting of the Scandinavian College of Neuro-psychopharmacology, Juan-les-Pins, France, 21–24 April 2004Google Scholar
- 6.Södra Regionsvårdsnämnden. 2006 price list for the University Hospital in Malmö, Region Skåne (2006)Google Scholar
- 7.Samverkansnämnden Västra Sjukvårdsregionen. Utomlänspriser 2006 För vårdtjänster enligt samverkansavtal om hälso-och sjukvård inom Västra sjukvårdsregionen. Västra Götalandsregionen (2006)Google Scholar
- 8.FASS (Swedish Drug Price List), The Swedish Association of the Pharmaceutical Industry (2006)Google Scholar