University of Alberta, Edmonton, AB, Canada.
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
BMC Psychiatry. 2022 Jul 2;22(1):444. doi: 10.1186/s12888-022-04075-y.
Long-acting injectable (LAI) antipsychotics, along with community treatment orders (CTOs), are used to improve treatment effectiveness through adherence among individuals with schizophrenia. Understanding real-world medication adherence, and healthcare resource utilization (HRU) and costs in individuals with schizophrenia overall and by CTO status before and after second generation antipsychotic (SGA)-LAI initiation may guide strategies to optimize treatment among those with schizophrenia.
This retrospective observational single-arm study utilized administrative health data from Alberta, Canada. Adults (≥ 18 years) with schizophrenia who initiated a SGA-LAI (no use in the previous 2-years) between April 1, 2014 and March 31, 2016, and had ≥ 1 additional dispensation of a SGA-LAI were included; index date was the date of SGA-LAI initiation. Medication possession ratio (MPR) was determined, and paired t-tests were used to examine mean differences in all-cause and mental health-related HRU and costs (Canadian dollars), comprised of hospitalizations, physician visits, emergency department visits, and total visits, over the 2-year post-index and 2-year pre-index periods. Analyses were stratified by presence or absence of an active CTO during the pre-index and/or post-index periods.
Among 1,211 adults with schizophrenia who initiated SGA-LAIs, 64% were males with a mean age of 38 (standard deviation [SD] 14) years. The mean overall antipsychotic MPR was 0.39 (95% confidence interval [CI] 0.36, 0.41) greater during the 2-year post-index period (0.84 [SD 0.26]) compared with the 2-year pre-index period (0.45 [SD 0.40]). All-cause and mental health-related HRU and costs were lower post-index versus pre-index (p < 0.001) for hospitalizations, physician visits, emergency department visits, and total visits; mean total all-cause HRU costs were $33,788 (95% CI -$38,993, -$28,583) lower post- versus pre-index ($40,343 [SD $68,887] versus $74,131 [SD $75,941]), and total mental health-related HRU costs were $34,198 (95%CI -$39,098, -$29,297) lower post- versus pre-index ($34,205 [SD $63,428] versus $68,403 [SD $72,088]) per-patient. Forty-three percent had ≥ 1 active CTO during the study period; HRU and costs varied according to CTO status.
SGA-LAIs are associated with greater medication adherence, and lower HRU and costs however the latter vary according to CTO status.
长效注射（LAI）抗精神病药与社区治疗令（CTO）一起，通过提高精神分裂症患者的依从性来提高治疗效果。了解精神分裂症患者总体及 CTO 状态前后第二代抗精神病药（SGA）-LAI 起始后真实世界的药物依从性以及医疗资源利用（HRU）和成本，可能有助于优化精神分裂症患者的治疗策略。
本回顾性观察性单臂研究利用了来自加拿大艾伯塔省的医疗保健数据。2014 年 4 月 1 日至 2016 年 3 月 31 日期间，≥18 岁且在过去 2 年内未使用过 SGA-LAI 的精神分裂症患者开始使用 SGA-LAI（首次使用），并且至少有另外一次 SGA-LAI 的配药记录；索引日期为 SGA-LAI 开始的日期。确定药物使用量（MPR），采用配对 t 检验，比较 2 年索引后和 2 年索引前时期的所有原因和精神健康相关的 HRU 和成本（加拿大元）的均值差异，包括住院、就诊、急诊就诊和总就诊次数。根据索引前和/或索引后时期 CTO 的存在情况对分析进行分层。
在 1211 名开始使用 SGA-LAI 的精神分裂症成人患者中，64%为男性，平均年龄为 38 岁（标准差[SD] 14）。2 年索引后时期的整体抗精神病药 MPR 平均增加了 0.39（95%置信区间[CI] 0.36，0.41）（0.84 [SD 0.26]），而 2 年索引前时期的 MPR 为 0.45（SD 0.40）。与索引前时期相比，索引后时期所有原因和精神健康相关的 HRU 和成本均较低（p<0.001），包括住院、就诊、急诊就诊和总就诊次数；总所有原因 HRU 成本在索引后时期比索引前时期平均降低了 33788 加元（95%CI -38993 加元，-28583 加元）（40343 加元 [SD 68887 加元] 与 74131 加元 [SD 75941 加元]），总精神健康相关 HRU 成本降低了 34198 加元（95%CI -39098 加元，-29297 加元）（34205 加元 [SD 63428 加元] 与 68403 加元 [SD 72088 加元]）。研究期间，43%的患者有≥1 次有效的 CTO；HRU 和成本根据 CTO 状态而有所不同。
SGA-LAI 与更高的药物依从性以及更低的 HRU 和成本相关，然而后者根据 CTO 状态而有所不同。
