a Health Services Research , Partnership for Health Analytic Research, LLC , Beverly Hills , CA , USA.
b Health Economics & Outcomes Research , Otsuka Pharmaceutical Development & Commercialization, Inc. , Princeton , NJ , USA.
Curr Med Res Opin. 2019 Jul;35(7):1231-1239. doi: 10.1080/03007995.2019.1571295. Epub 2019 Jan 31.
Early initiation of antipsychotic treatment in schizophrenia is associated with improved outcomes. This study aimed to determine if initiation of long-acting injectable (LAI) antipsychotic treatment early in a new schizophrenia episode is associated with lower hospitalization rates and healthcare costs in a real-world setting. This retrospective (January 1, 2007-June 30, 2016) cohort analysis used claims from Truven Health Analytics MarketScan Commercial, Medicaid, and Medicare Supplemental databases. In adults ≥18 years with a new episode of schizophrenia, two mutually exclusive cohorts were identified based on time from first recorded schizophrenia diagnosis date to first date of LAI initiation (index date): ≤1 year (early initiators) and >1 year (late initiators). Logistic and general linear regression models were performed to estimate adjusted hospitalization rate and healthcare costs in a 1-year follow-up, controlling patient demographic and clinical characteristics, insurance type, baseline all-cause hospitalizations and ED visits, and baseline psychiatric medication use. Of the subjects, 32% ( = 1388) initiated treatment early and 68% ( = 2978) initiated treatment later. In risk-adjusted models, all-cause hospitalization rates were 22.2% (95% CI = 19.9-24.6%) in early initiators and 26.9% (95% CI = 25.2-28.7%) in late initiators ( = .002). Of early initiators, 14.1% (95% CI = 12.3-16.1%) had a psychiatric hospitalization vs 19.2% (95% CI = 17.7-20.8%) of late initiators ( < .001). Adjusted psychiatric healthcare costs were significantly lower in early initiators compared with late initiators [mean (95% CI) = $21,545 (20,355-22,734) vs $24,132 (23,330-24,933)] ( < .001). LAI initiation within 1 year of a new schizophrenia episode led to lower hospitalization rates and healthcare costs compared with LAI initiation more than 1 year after a new episode.
早期开始抗精神病药物治疗精神分裂症可改善预后。本研究旨在确定在新的精神分裂症发作中早期开始长效注射（LAI）抗精神病药物治疗是否与现实环境中的住院率和医疗保健成本降低有关。这项回顾性（2007 年 1 月 1 日至 2016 年 6 月 30 日）队列分析使用了 Truven Health Analytics MarketScan 商业、医疗补助和医疗保险补充数据库中的索赔数据。在患有新发作的精神分裂症的成年人中，根据从首次记录的精神分裂症诊断日期到首次 LAI 起始日期的时间，确定了两个相互排斥的队列：≤1 年（早期起始者）和＞1 年（晚期起始者）。使用逻辑回归和广义线性回归模型，在 1 年的随访期间，根据患者人口统计学和临床特征、保险类型、基线全因住院和急诊就诊以及基线精神科药物使用情况，估算调整后的住院率和医疗保健成本。在研究对象中，32%（n=1388）的患者早期开始治疗，68%（n=2978）的患者晚期开始治疗。在风险调整模型中，早期起始者的全因住院率为 22.2%（95%CI=19.9-24.6%），晚期起始者为 26.9%（95%CI=25.2-28.7%）（P=0.002）。在早期起始者中，14.1%（95%CI=12.3-16.1%）有精神科住院治疗，而晚期起始者中为 19.2%（95%CI=17.7-20.8%）（P<0.001）。与晚期起始者相比，早期起始者的调整后精神科医疗保健费用明显较低[平均值（95%CI）=21545 美元（20355-22734）比 24132 美元（23330-24933）]（P<0.001）。与新发作后 1 年以上开始 LAI 治疗相比，新的精神分裂症发作后 1 年内开始 LAI 治疗可降低住院率和医疗保健成本。
