Comparison of Resource use and Health Care Costs in New Initiators of Long-Acting Injectable (Lai) and Oral Second Generation Antipsychotics.

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To measure health care utilization and costs among new initiators of LAI and oral second generation antipsychotics with schizophrenia or bipolar disorder. A large database of a commercially insured US population was used to index patients on their first treatment between 1/1/2011 and 12/31/2011. Patients were required to have ≥ 12 months pre-index and ≥ 12 months post-index, were new users of a second generation antipsychotic, and diagnosed with schizophrenia or bipolar disorder during their pre-index period. LAI and oral patients were matched 1: 3 using propensity scores. Mean differences in annual resource use and costs were compared across groups in an unadjusted difference-in-difference analysis: [ (LAI post - LAI pre) - (Oral post - Oral pre) ]. Initial selection identified 250 LAI and 8,356 oral treatment patients. Matching resulted in balanced cohorts of 204 LAI and 612 oral initiators. Annual hospitalizations and ER visits from pre-index to post-index was significantly lower in LAI initiators compared to oral initiators. Mean annual hospitalizations per LAI patient reduced from 1.09 to 0.51 (p < 0.0001) while that of the oral cohort reduced from 0.53 to 0.39 (p = 0.0011). This resulted in a net reduction of 0.45 annual hospitalizations per patient in the LAI cohort, using the oral cohort as a reference (p < 0.0001). Mean annual ER visits reduced from 1.72 to 1.03 per LAI patient compared to no change in the oral cohort, resulting in a net difference of 0.72 ER visits between the two groups (p <0.0001). The unadjusted difference-in-difference analysis showed a relative reduction in total health care costs of $4,997 in the LAI cohort compared to the oral cohort. Initiating treatment with an LAI resulted in greater reductions in hospitalizations and ER visits compared to oral second generation antipsychotic medications in patients with schizophrenia or bipolar disease.