Hospitalization Resource Utilization and Costs Among Medicaid Insured Patients With Schizophrenia With Different Treatment Durations of Long-Acting Injectable Antipsychotic Therapy

Bera, Rimal; Offord, Steve J.; Zubek, Donna; Lau, Gina; Lin, Jay; Karson, Craig N.

doi:10.1097/jcp.0b013e3182a6082a

Cited by 5 publications

(3 citation statements)

References 18 publications

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“…Similarly, a study in a home health care setting in Taiwan showed a significantly lower risk for psychiatric rehospitalization in patients receiving LAI antipsychotics than those treated with oral medication [ 25 ]. In addition, a United States Medicaid database study reported that use of LAI medications is associated with a longer time to the first hospitalization for any cause and for schizophrenia; moreover, the authors also reported that a longer use duration of LAI antipsychotics (at least 6 months relative to those treated for shorter durations) is associated with a decreased number of hospitalizations, decreased hospital length of stay, and reduced hospital payment—thus using fewer hospital resources [ 26 ]. Findings from randomized clinical trials of olanzapine LAI have also produced similar results indicating favorable changes in hospitalization [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Baseline characteristics and hospitalizations in patients with schizophrenia receiving olanzapine long-acting injection: an interim analysis from a non-interventional, prospective observational safety study

et al. 2015

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BackgroundDepot antipsychotics are a treatment option for medication nonadherence in patients with schizophrenia. Nonadherence can lead to increased relapse and hospitalization rates. This article reports hospitalization data before and after initiation of olanzapine long-acting injection (LAI), a depot antipsychotic.MethodsData were assessed from an ongoing, multinational, prospective, observational post-authorisation safety study being conducted to evaluate post-injection delirium/sedation syndrome (PDSS), an adverse reaction that can occur following injection of olanzapine LAI. Eligible patients were aged ≥18 years, diagnosed with schizophrenia, were prescribed olanzapine LAI, and lived outside the United States. Psychiatric hospitalization and medication data were collected retrospectively for the 6-month period before study entry and prospectively throughout the study. Paired t-tests and McNemar’s tests were used to assess changes in hospitalization incidence and duration. Stepwise Cox proportional hazards models assessed factors associated with hospitalizations. Analyses were based on data from the first 3 years of the continuously enrolling study (N = 668).ResultsThe average duration of olanzapine LAI exposure for all patients was 0.768 years. Of the 529 patients who received at least 1 injection of olanzapine LAI and were not hospitalized at study entry, 8.1 % had at least 1 subsequent psychiatric hospitalization with a mean duration of 2.0 days. Of the 288 patients who had a >6-month follow-up, 8.3 % had at least 1 post-baseline psychiatric hospitalization with a mean duration of 2.3 days. The incidence of hospitalizations in the 6-month period after treatment was significantly lower than that in the 6-month period prior to treatment (8.3 vs 32.6 %, respectively; P < 0.001). Furthermore, mean hospitalization duration decreased from 11.5 days in the 6-month period before treatment to 2.3 days in the 6-month period after treatment (P < 0.001). Psychiatric hospitalization in the prior 12 months (P < 0.0001) and recreational drug use within 24 h of baseline visit (P = 0.015) were identified as potential predictors of time to first psychiatric hospitalization after beginning to take olanzapine LAI. At the time of interim analysis, 5 PDSS events had occurred, which was too few for a full analysis of those events.ConclusionsResults indicate a significant reduction in the incidence and days of hospitalization from the 6-month period before to the 6-month period after olanzapine LAI initiation, which suggests reduced relapse and hospitalization during treatment. Results should be interpreted with caution due to the observational nature of the study and use of retrospective baseline data.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-015-0669-5) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Baseline characteristics and hospitalizations in patients with schizophrenia receiving olanzapine long-acting injection: an interim analysis from a non-interventional, prospective observational safety study

et al. 2015

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“…LAIs have been associated with both reduced hospitalization rates and care costs [17-19]. Clinical guidelines on LAI usage have been published, recommending that LAIs should not only be used to address nonadherence but also if patients have a basic preference for this formulation––for convenience or any other reason [20-22].…”

Section: Introductionmentioning

confidence: 99%

Patient and prescriber perspectives on long-acting injectable (LAI) antipsychotics and analysis of in-office discussion regarding LAI treatment for schizophrenia

et al. 2013

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BackgroundThe research goal is to better understand prescriber, patient, and caregiver perspectives about long-acting injectable (LAI) antipsychotic therapy and how these perspectives affect LAI use. Addressing these perspectives in the clinic may lead to greater success in achieving therapeutic goals for the patient with schizophrenia.MethodsEthnographic information was collected from a non-random sample of 69 prescriber-patient conversations (60 with community mental health center [CMHC] psychiatrists; 9 with nurse-practitioners) recorded during treatment visits from August 2011 to February 2012, transcribed and analyzed. Discussions were categorized according to 11 predetermined CMHC topics. In-person observations were also conducted at 4 CMHCs, including home visits by researchers (n = 15 patients) prior to the CMHC visit and observations of patients receiving injections and interacting with staff. Telephone in-depth interviews with psychiatrists, patients, and caregivers to gather additional information on LAI discussion, prescription, or use were conducted.ResultsAntipsychotic treatment decisions were made without patient or caregiver input in 40 of 60 (67%) of psychiatrist-patient conversations. Involvement of patients or caregivers in treatment decisions was greater when discussing LAI (15 of 60 [25%]) vs oral antipsychotic treatment (5 of 60 [8%]). LAIs were not discussed by psychiatrists in 11 of 22 (50%) patients taking oral antipsychotics. When offered, more LAI-naïve patients expressed neutral (9 of 19 [47%]) rather than favorable (3 of 19 [16%]) or unfavorable (7 of 19 [37%]) responses. Prescribers were most concerned about potentially damaging the therapeutic relationship and side-effects when discussing LAIs while patient resistance was often related to negative feelings about injections. Psychiatrists had some success in overcoming patient objections to LAIs by addressing and decomposing initial resistance. More than half (11 of 19 [58%]) of LAI-naïve patients agreed to start LAI treatment following office visits. Patient-described benefits of LAIs vs orals included perceived rapid symptom improvement and greater overall efficacy.ConclusionsIn this study, many psychiatrists did not offer LAIs and most patients and caregivers were not involved in antipsychotic treatment decision making. Opportunities to increase active patient engagement, address resistances, guide patient drug-formulation selection, and provide better LAI-relevant information for more individualized approaches to treating the patient with schizophrenia were present.

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“…During the 12-month follow-up period, patients treated with LAI compared to oral antipsychotics had significantly lower average inpatient costs, higher average pharmacy costs, and similar total health care costs. 111 A recent Medicaid health care utilization study 112 in the United States compared health care utilization and treatment costs for hospitalized patients with schizophrenia who had been on short-duration LAI treatment (defined as 30-79 days; n = 2,856) versus longer-term LAI treatment (≥ 180 days; n = 2,838). The longer-term LAI patients had significantly lower levels of some health care utilization measures, including mean number of hospitalizations and mean length of hospital stay.…”

Section: Effect Of Lais On Adherence and Costsmentioning

confidence: 99%

The Use of Long-Acting Injectable Antipsychotics in Schizophrenia

Correll¹,

Citrome²,

Haddad³

et al. 2016

J. Clin. Psychiatry

286

276

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Hospitalization Resource Utilization and Costs Among Medicaid Insured Patients With Schizophrenia With Different Treatment Durations of Long-Acting Injectable Antipsychotic Therapy

Cited by 5 publications

References 18 publications

Baseline characteristics and hospitalizations in patients with schizophrenia receiving olanzapine long-acting injection: an interim analysis from a non-interventional, prospective observational safety study

Baseline characteristics and hospitalizations in patients with schizophrenia receiving olanzapine long-acting injection: an interim analysis from a non-interventional, prospective observational safety study

Patient and prescriber perspectives on long-acting injectable (LAI) antipsychotics and analysis of in-office discussion regarding LAI treatment for schizophrenia

The Use of Long-Acting Injectable Antipsychotics in Schizophrenia

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