Evaluation of health services use following the initiation of risperidone long-acting therapy among schizophrenia patients in the veterans health administration

Ren, Xinhua S.; Crivera, Concetta; Sikirica, Mirko; Dirani, Riad; Qian, Shirley; Kazis, Lewis E.

doi:10.1111/j.1365-2710.2010.01211.x

Cited by 15 publications

(9 citation statements)

References 20 publications

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“…Consistent with the findings of the current study, the existing literature includes reports of the efficacy of PP with respect to reducing hospitalization rates and costs in patients with schizophrenia compared to placebo [17] and OAT medications [4,10,18]; one of those studies involved a within-patients comparison [9,19]. Our results are consistent with prior findings that once-monthly administration of PP enhances treatment adherence, ultimately reducing the economic burden associated with schizophrenia.…”

Section: Discussionsupporting

confidence: 91%

“…In a previous 12-week study, patients with schizophrenia showed improved symptoms and reduced side effects, such as extrapyramidal symptoms, when previous OAT medications were replaced with LAIs, regardless of the type of OAT medication [20]. Similarly, previous studies have demonstrated that patients treated with LAIs made more outpatient visits, for regular administration of injections [19] and because of their transition to outpatient treatment following early discharge from the hospital [14].…”

Section: Discussionmentioning

confidence: 92%

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Effects of Paliperidone Palmitate on Healthcare Utilization and Costs for Patients with Schizophrenia: A Claim-based Mirror-image Study in South Korea

Lee¹,

Lee

Choi

et al. 2020

Clin Psychopharmacol Neurosci

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Objective: Long-acting injectable (LAI) antipsychotics, such as paliperidone palmitate (PP), are known to improve treatment adherence in patients with schizophrenia, which can lead to reductions in relapse and hospitalization rates. However, relatively few studies have demonstrated the economic impact of LAIs, especially in Asian populations. Methods: We conducted a claim-based mirror-image study to explore changes in healthcare utilization and associated costs, among 1,272 South Korean patients with schizophrenia (ICD-10-CM code F20), between the 1-year periods before and after the initiation of PP treatment. Results: Patients accessed outpatient services more frequently after versus before starting PP treatment, with the number of prescription days increasing by 133.45 (p ＜ 0.0001) and the associated costs increasing by USD 1,497.15 (p ＜ 0.0001). The number of admission days was reduced by 11.33 after starting PP treatment (p ＜ 0.0001) and the associated costs were reduced by USD 1,220.75 (p ＜ 0.0001). However, admission cost savings were different according to patients' oral drug compliance. The daily dosages for benztropine, procyclidine, and propranolol decreased, showing that there were fewer side-effects after PP-treatment (p ＜ 0.0001). Conclusion: Although the high acquisition cost of PP has been regarded as an obstacle to its clinical use, our results imply that the high prescription costs for PP may be counterbalanced by the reduced admission costs associated with its use. Economic outcomes for patients treated with LAIs should be investigated further to help healthcare decision-makers and providers to determine the value of LAIs relative to other treatment medications.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 92%

Effects of Paliperidone Palmitate on Healthcare Utilization and Costs for Patients with Schizophrenia: A Claim-based Mirror-image Study in South Korea

Lee¹,

Lee

Choi

et al. 2020

Clin Psychopharmacol Neurosci

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“…Ren et al studied patients who initiated LAIs in a Veterans Administration clinic for psychiatric outpatient visits and hospitalizations. 31 Among 924 patients, the number of psychiatric-related outpatient visits increased from 24.6 to 39.1 ( P <0.001), the number of psychiatric hospitalizations decreased from 1.4 to 1.0 ( P <0.001), and the average inpatient length of stay was reduced from 20 to 14 days ( P <0.001). The proportion of patients who experienced at least one psychiatric-related hospitalization decreased from 68.9% to 45.7% ( P <0.001), and the proportion with two hospitalizations decreased from 34.9% to 24.4% ( P <0.001).…”

Section: Lais and Schizophrenia Outcomesmentioning

confidence: 98%

Impact of long-acting injectable antipsychotics on medication adherence and clinical, functional, and economic outcomes of schizophrenia

Kaplan

Casoy

Zummo³

2013

PPA

149

127

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Schizophrenia is a debilitating chronic disease that requires lifelong medical care and supervision. Even with treatment, the majority of patients relapse within 5 years, and suicide may occur in up to 10% of patients. Poor adherence to oral antipsychotics is the most common cause of relapse. The discontinuation rate for oral antipsychotics in schizophrenia ranges from 26% to 44%, and as many as two-thirds of patients are at least partially nonadherent, resulting in increased risk of hospitalization. A very helpful approach to improve adherence in schizophrenia is the use of long-acting injectable (LAI) antipsychotics, although only a minority of patients receive these. Reasons for underutilization may include negative attitudes, perceptions, and beliefs of both patients and health care professionals. Research shows, however, significant improvements in adherence with LAIs compared with oral drugs, and this is accompanied by lower rates of discontinuation, relapse, and hospitalization. In addition, LAIs are associated with better functioning, quality of life, and patient satisfaction. A need exists to encourage broader LAI use, especially among patients with a history of nonadherence with oral antipsychotics. This paper reviews the impact of nonadherence with antipsychotic drug therapy overall, as well as specific outcomes of the schizophrenia patient, and highlights the potential benefits of LAIs.

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“… 2) Indeed, several studies have demonstrated that LAI antipsychotics may maintain medication adherence and prevent relapse. 11 – 16) However, the majority of psychiatrists use LAI antipsychotics very conservatively, particularly in Asian countries. 17 , 18) …”

Section: Main Subjectsmentioning

confidence: 99%

Holistic Consideration of Patients with Schizophrenia to Improve Medication Adherence and Outcomes

Lee

Chen

Chang

et al. 2015

Clin Psychopharmacol Neurosci

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Although several algorithms have been applied to treat patients with schizophrenia, their clinical use remains still limited, because most emphasize the prescription of antipsychotics. A new algorithm with a more holistic approach to treating patients with schizophrenia, to be used before applying traditional prescribing guidelines, was thus proposed by an expert team of Taiwanese psychiatrists. In this algorithm, several important treatment tasks/modalities are proposed, including long-acting injection anti-psychotics, shared decision-making, a case management system, compulsory treatment by law, community rehabilitation programs, the patients’ feeling about their health care professionals (patients’ behaviors) and their attitude/knowledge of their conditions/illness. This study proposes that evaluating the medication adherence of patients can be determined by two key domains, namely patients’ behaviors and attitudes. Based on different levels of their behaviors (X-axis) and attitude/knowledge (Y-axis), it is possible to categorize patients with schizophrenia into six subgroups, for which various different interventions, including the use of antipsychotics, could be applied and integrated. Further research is needed to assess the applicability of this treatment algorithm in clinical settings.

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Evaluation of health services use following the initiation of risperidone long-acting therapy among schizophrenia patients in the veterans health administration

Cited by 15 publications

References 20 publications

Effects of Paliperidone Palmitate on Healthcare Utilization and Costs for Patients with Schizophrenia: A Claim-based Mirror-image Study in South Korea

Effects of Paliperidone Palmitate on Healthcare Utilization and Costs for Patients with Schizophrenia: A Claim-based Mirror-image Study in South Korea

Impact of long-acting injectable antipsychotics on medication adherence and clinical, functional, and economic outcomes of schizophrenia

Holistic Consideration of Patients with Schizophrenia to Improve Medication Adherence and Outcomes

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