Real-world medication adherence and healthcare costs of patients with schizophrenia initiating long-acting injectable (LAI) vs. oral antipsychotics were compared. Patients with schizophrenia initiating LAI or oral antipsychotics (index event) were identified from MarketScan Commercial and Medicare claims databases and their medication possession ratios (MPR), pre- and post-index costs for inpatient/outpatient care were compared. Of 3,004 patients, 394 initiated LAI antipsychotics and 2,610 oral antipsychotics. Post-index, the mean MPR was greater for the LAI cohort (0.67 ± 0.34 vs. 0.56 ± 0.35; p < 0.001). Schizophrenia-related hospital costs for LAI users were reduced during the follow-up period in comparison to the pre-index period, but were increased for patients using oral antipsychotics (-$5,981 ± $16,554 vs. 758 ± 14,328, p < 0.001). The change in costs of outpatient care also favored LAI medications ($134 ± 8,280 vs. 658 ± 3,260, p = 0.023). Drug costs of LAI antipsychotics were higher ($4,132 ± 4,533 vs. 2,562 ± 2,714, p < 0.001). Schizophrenia patients initiating LAI antipsychotics incur less healthcare costs in comparison to patients initiating oral antipsychotics.
Schizophrenia Antipsychotic Medication Medication Possession Ratio Antipsychotic Therapy Prescription Drug Coverage
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.
Conflict of Interest
Declaration of funding—this research was supported by Otsuka America Pharmaceutical, Inc. and H. Lundbeck A/S. Declaration of financial/other relationships—Jay Lin is an employee of Novosys Health, which has received research funds from Otsuka America Pharmaceutical, Inc. in connection with conducting this study and development of this manuscript. Bruce Wong is a paid consultant for Otsuka America Pharmaceutical, Inc. in connection with conducting this study and development of this manuscript. Steve Offord and Dario Mirski are employees of Otsuka America Pharmaceutical, Inc.
Horvitz-Lennon M, Donohue JM, Domino ME, et al. Improving quality and diffusing best practices: the case of schizophrenia. Health Affairs 2009;28(3):701–12.PubMedCrossRefGoogle Scholar
Wu EQ, Birnbaum HG, Shi L, et al. The economic burden of schizophrenia in the United States in 2002. The Journal of Clinical Psychiatry 2005;66(9):1122–9.PubMedCrossRefGoogle Scholar
Lambert T, Olivares JM, Peuskens J, et al. Effectiveness of injectable risperidone long-acting therapy for schizophrenia: data from the US, Spain, Australia, and Belgium. Annals of General Psychiatry 2011;10:10.PubMedCrossRefGoogle Scholar
Lacro JP, Dunn LB, Dolder CR, et al. Prevalence of and risk factors for medication nonadherence in patients with schizophrenia: a comprehensive review of recent literature. The Journal of Clinical Psychiatry 2002;63(10):892–909.PubMedCrossRefGoogle Scholar
West JC, Wilk JE, Olfson M, et al. Patterns and quality of treatment for patients with schizophrenia in routine psychiatric practice. Psychiatric Services 2005;56(3):283–91.PubMedCrossRefGoogle Scholar
Valenstein M, Copeland LA, Owen R, et al. Adherence assessments and the use of depot antipsychotics in patients with schizophrenia. The Journal of Clinical Psychiatry 2001;62(7):545–51.PubMedCrossRefGoogle Scholar
Kelin K, Lambert T, Brnabic AJ, et al. Treatment discontinuation and clinical outcomes in the 1-year naturalistic treatment of patients with schizophrenia at risk of treatment nonadherence. Patient Preference and Adherence 2011;5:213–22.PubMedCrossRefGoogle Scholar
Sun SX, Liu GG, Christensen DB, et al. Review and analysis of hospitalization costs associated with antipsychotic nonadherence in the treatment of schizophrenia in the United States. Current Medical Research and Opinion 2007;23(10):2305–12.PubMedCrossRefGoogle Scholar
Ascher-Svanum H, Zhu B, Faries DE, et al. The cost of relapse and the predictors of relapse in the treatment of schizophrenia. BMC psychiatry 2010;10:2.PubMedCrossRefGoogle Scholar
Adams C E, Fenton MKP, Quraishi S, et al. Systematic meta-review of depot antipsychotic drugs for people with schizophrenia. The British Journal of Psychiatry 2001;179(4):290–299.PubMedCrossRefGoogle Scholar
Gaebel W, Schreiner A, Bergmans P, et al. Relapse prevention in schizophrenia and schizoaffective disorder with risperidone long-acting injectable vs quetiapine: results of a long-term, open-label, randomized clinical trial. Neuropsychopharmacology 2010;35(12):2367–77.PubMedCrossRefGoogle Scholar
Rosenheck RA, Krystal JH, Lew R, et al. Long-acting risperidone and oral antipsychotics in unstable schizophrenia. The New England Journal of Medicine 2011;364(9):842–51.PubMedCrossRefGoogle Scholar
US Department of Health and Human Services. Code of Federal Regulations. Human Subjects Research (45 CFR 46).Google Scholar
West JC, Marcus SC, Wilk J, et al. Use of depot antipsychotic medications for medication nonadherence in schizophrenia. Schizophrenia Bulletin 2008;34(5):995–1001.PubMedCrossRefGoogle Scholar
Shi L, Ascher-Svanum H, Zhu B, et al. Characteristics and use patterns of patients taking first-generation depot antipsychotics or oral antipsychotics for schizophrenia. Psychiatric Services 2007;58(4):482–8.PubMedCrossRefGoogle Scholar
Bernardo M, San L, Olivares JM, et al. Treatment patterns and health care resource utilization in a 1-year observational cohort study of outpatients with schizophrenia at risk of nonadherence treated with long-acting injectable antipsychotics. Patient Preference and Adherence 2011;5:601–10..PubMedGoogle Scholar
Lehman AF, Kreyenbuhl J, Buchanan RW, et al. The Schizophrenia Patient Outcomes Research Team (PORT): updated treatment recommendations 2003. Schizophrenia Bulletin 2004;30(2):193–217.PubMedCrossRefGoogle Scholar
Lehman AF, Steinwachs DM. Translating research into practice: the Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations. Schizophrenia Bulletin 1998;24(1):1–10.PubMedCrossRefGoogle Scholar
Ascher-Svanum H, Peng X, Faries D, et al. Treatment patterns and clinical characteristics prior to initiating depot typical antipsychotics for nonadherent schizophrenia patients. BMC Psychiatry 2009;9:46.PubMedCrossRefGoogle Scholar
Akincigil A, Hoover DR, Walkup JT, et al. Hospitalization for psychiatric illness among community-dwelling elderly persons in 1992 and 2002. Psychiatric Services 2008;59(9):1046–8.PubMedCrossRefGoogle Scholar
Heres S, Hamann J, Kissling W, et al. Attitudes of psychiatrists toward antipsychotic depot medication. The Journal of Clinical Psychiatry 2006;67(12):1948–53.PubMedCrossRefGoogle Scholar
Yu AP, Atanasov P, Ben-Hamadi R, et al. Resource utilization and costs of schizophrenia patients treated with olanzapine versus quetiapine in a Medicaid population. Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research 2009;12(5):708–15.CrossRefGoogle Scholar