Magazine article Clinical Psychiatry News

Depot Antipsychotics May Improve Outcomes, Lower Cost

Magazine article Clinical Psychiatry News

Depot Antipsychotics May Improve Outcomes, Lower Cost

Article excerpt

HOLLYWOOD, FLA. - Once patients were switched from oral antipsychotic agents to long-acting injectable ones, their annual all-cause hospitalization rate was cut by more than half in an observational study involving nearly 6,000 Medicaid patients with schizophrenia.

Moreover, the mean number of days per year spent in the hospital for any reason also dropped dramatically after the switch. Plus, the mean overall annual health care costs decreased by $6,901, Dr. Craig N. Karson said at a meeting of the New Clinical Drug Evaluation Unit sponsored by the National Institute of Mental Health.

Noting that American Psychiatric Association practice guidelines support the use of long-acting injectable antipsychotics in patients who are repeatedly nonadherent to oral agents, Dr. Karson said the new study of Medicaid patients argues for resorting to depot medications earlier.

"We may have an opportunity here to improve the management of schizophrenia, and in particular the cost management," said Dr. Karson, a psychiatrist in Wayne, Pa.

He presented a retrospective longitudinal study of 5,694 Medicaid patients with schizophrenia who switched from oral to long-acting injectable antipsychotics during 20052010. The data came from the Thomson Reuters MarketScan Research Medicaid Database.

Forty-four percent of patients were placed on long-acting injectable risperidone, 41% on haloperidol, and the rest on fluphenazine, which were the three antipsychotics available in depot form in the study period.

Roughly 80% of the all-cause hospitalizations in this study were for schizophrenia.

The switch from oral to long-acting injectable antipsychotic agents was associated with a striking reduction in overall health care resource use, including a decrease in the mean annual number of all-cause hospitalizations from 1.52 to 0.70. (See box.)

To see whether patients duration on long-acting injectable antipsychotics was related to health care resource use, Dr. Karson and his coinvestigators divided the study population into two groups: the 2,856 patients who were short-term users of long-acting injectable therapy, defined as less than 180 days of treatment; and the 2,838 users of long-acting injectables for at least 180 days. The short-term users averaged 0.79 all-cause hospitalizations annually; the long-term users, 0.61. The mean annualized total days in the hospital was 6.56 for the short-term users, compared with 4.93 in longer-term users. …

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