Department of Psychiatry and Human Behavior, Jefferson Health-Sidney Kimmel Medical College, Thomas Jefferson University, 33 S 9th St, Ste 210, Philadelphia, PA, USA.
Alkermes, Waltham, MA, USA.
CNS Drugs. 2021 Oct;35(10):1123-1135. doi: 10.1007/s40263-021-00849-2. Epub 2021 Sep 21.
Continuous antipsychotic therapy is recommended as part of long-term maintenance treatment of schizophrenia, and gaps in antipsychotic treatment have been associated with increased risks of relapse and rehospitalization. Because the use of long-acting injectable (LAI) antipsychotics may reduce the likelihood of undetected medication gaps, initiating an LAI medication may affect resource utilization and costs. The LAI aripiprazole lauroxil (AL) was approved in the United States (US) in 2015 for the treatment of schizophrenia in adults.
The objective of this retrospective observational cohort study was to examine treatment patterns, resource utilization, and costs following initiation of AL for the treatment of schizophrenia in adults.
A retrospective analysis of Medicaid claims data identified a cohort of patients (N = 485) starting AL shortly after Food and Drug Administration approval in October 2015. Treatment patterns, resource utilization, and costs were compared 6 months before and after treatment initiation. Subgroup analyses were conducted based on the type of antipsychotic (LAI, oral, or none) received before initiation of AL.
Over 6 months of follow-up, patients received an average of 4.6 injections out of a maximum of six (77%). After initiating AL, all-cause inpatient admissions decreased by 22.4%; other significant reductions were observed in mental health-related admissions and emergency room (ER) visits. All-cause inpatient costs decreased by an average of US$2836 per patient (p < 0.05) in the 6-month post-AL period, whereas outpatient pharmacy costs increased by US$4121 (p < 0.05), resulting in no significant difference in overall costs between the pre- and post-AL periods. The subgroup of patients who had been prescribed an oral antipsychotic before starting AL had significant reductions in proportion of patients with inpatient and ER visits and costs, but also reported a significant increase in pharmacy costs.
AL was associated with a significant reduction in inpatient costs and an increase in outpatient pharmacy costs, resulting in no changes in total healthcare costs over 6 months. The adherence rate and reductions in inpatient use may indicate the potential for greater clinical stability among patients initiated on AL compared with their previous treatment.
持续的抗精神病药物治疗被推荐作为精神分裂症长期维持治疗的一部分，而抗精神病药物治疗的中断与复发和再住院风险的增加有关。由于使用长效注射（LAI）抗精神病药物可能会降低未被发现的药物中断的可能性，因此开始使用 LAI 药物可能会影响资源的利用和成本。LAI 阿立哌唑月桂酸酯（AL）于 2015 年在美国（美国）获得批准，用于治疗成人精神分裂症。
本回顾性观察队列研究的目的是检查成人开始使用 AL 治疗精神分裂症后的治疗模式、资源利用和成本。
对医疗补助索赔数据进行回顾性分析，确定了一组在 2015 年 10 月 FDA 批准后不久开始使用 AL 的患者（N=485）。比较了治疗开始前 6 个月和治疗开始后的治疗模式、资源利用和成本。根据开始使用 AL 之前接受的抗精神病药物（LAI、口服或无）的类型进行了亚组分析。
在 6 个月的随访中，患者平均接受了最多 6 次注射中的 4.6 次（77%）。开始使用 AL 后，全因住院人数减少了 22.4%；精神卫生相关住院和急诊室（ER）就诊也显著减少。在 AL 后 6 个月期间，每位患者的全因住院费用平均减少了 2836 美元（p<0.05），而门诊药房费用增加了 4121 美元（p<0.05），因此在 AL 前后期间，总医疗成本没有显著差异。在开始使用 AL 之前接受过口服抗精神病药物治疗的患者亚组，住院和 ER 就诊的患者比例以及费用均显著减少，但药房费用也显著增加。
AL 与住院费用的显著降低和门诊药房费用的增加有关，在 6 个月内总医疗保健费用没有变化。依从率和住院使用的减少可能表明与之前的治疗相比，开始使用 AL 的患者具有更大的临床稳定性。
