PMH52 - The Long-Term Benefits of Ensuring Timely Treatment and Improved Medication Adherence in Early Schizophrenia: A Microsimulation Study

Abstract

In early-stage schizophrenia, the duration of untreated psychosis (DUP) accrued prior to treatment entry is known to have long-term prognostic implications. Emerging evidence suggests that “time in psychosis” accrued after treatment entry is similarly consequential. This evidence has spawned efforts to get patients into treatment earlier and ensure optimal treatment, including with antipsychotic drugs. We use a microsimulation model to quantify the 10-year impact of shortening overall time in uncontrolled psychosis, i.e., the sum of DUP and time in psychosis accrued due to ineffective antipsychotic treatment. The model varies DUP as a function of the success of efforts to promote treatment entry and in-treatment time in psychosis as a function of antipsychotic drug adherence affecting effectiveness. Patients enter treatment with a DUP randomly drawn from three published distributions (short, medium, and long). Based on published evidence, adherence is assumed to be 33% and 95% for oral and long-acting injectable (LAI) agents, respectively. Each ineffective treatment attempt increases DUP by three months. Accrued time in uncontrolled psychosis during the first three years predicts outcomes over the ensuing seven years. If only oral agents are used, short DUP is estimated to lead to relative reductions in schizophrenia-related hospital admissions of 12.6%-14.4% and receipt of disability benefits of 7.0%-8.5%, and relative increases in independent/family living of 41.5%-46% and competitive employment of 42%-58%, compared to medium and long DUPs, respectively. If patients with short DUP start LAI treatment after the second oral drug failure, admissions and receipt of disability benefits are reduced by an additional 17% and 40%, respectively, while probability of independent/family living and competitive employment increase by 27% and 49%, respectively. While these simulation results should be confirmed with direct empirical evidence, they imply substantial long-term benefits of combining timely treatment entry with pro-adherence interventions in early schizophrenia.