DU1 - Early Initiation of Long-Acting Injectable Antipsychotic Treatment is Associated with Lower Healthcare Resource Use and Costs in Patients with Schizophrenia

Abstract

To determine if early initiation of long-acting injectable (LAI) antipsychotic treatment is associated with lower healthcare resource use and cost in patients with schizophrenia. This retrospective cohort analysis used 9.5 years of claims data (1/1/2007–6/30/2016) from Truven Health MarketScan® Commercial, Medicaid, and Medicare Supplemental databases. In patients ≥18 years with a new episode of schizophrenia, two mutually exclusive cohorts were identified based on time from date of first schizophrenia diagnosis (the new episode) to first date of starting a LAI (index date): ≤1 year (early initiators) and >1 year (late initiators). Patients were required to have continuous enrollment between the new episode of schizophrenia and LAI initiation and for ≥1 year before (baseline) and after (follow-up) index date. Logistic and general linear regression models were performed to estimate the adjusted hospitalization rate and healthcare costs, controlling patient demographic and clinical characteristics, insurance type, baseline all-cause hospitalizations and emergency department visits, and baseline psychiatric medication use (including oral antipsychotic use). 31% (n=1,388) initiated treatment early and 68% (n=2,978) initiated later. In risk-adjusted models, all-cause hospitalization rates were 22.1% (95%CI, 19.8%-24.5%) in early initiators and 26.9% (95%CI 25.2%-28.7%) in late initiators (p<0.001). 14.0% (95%CI, 12.2%-16.0%) of early initiators had a psychiatric hospitalization compared with 19.2% (95%CI 17.7%-20.8%) of late initiators (p<0.001). Adjusted psychiatric healthcare costs were significantly lower in early initiators compared with late initiators [mean (95%CI) $21,337 (20,135-22,539) vs. $24,228 (23,419-25,038)] (p<0.001). Adjusted all-cause healthcare costs were lower in early initiators compared with late initiators [mean (95%CI) $34,661 (32,531-36,791) vs. $36,342 (34,907-37,777)], but the difference was not statistically significant (p=0.21). Schizophrenia patients who initiated a LAI early had lower hospitalization rates and healthcare costs compared with late LAI initiators.