Cost-consequences analysis of switching from oral antipsychotics to long-acting risperidone in the treatment of schizophrenia
2012
Lack of treatment adherence in schizophrenia often leads to
an increase in relapses and, consequentially, to an increase in
direct healthcare costs (e.g., hospitalizations). The aim of the
SMART study (Schizophrenia Medications Adherence: longacting
Risperidone versus other Therapies) was to assess the
variation in total direct health-related costs among schizophrenic
patients switching from oral antipsychotics to long-acting injectable
risperidone (LA-risperidone).
Materials and methods
A multicentre, retrospective, observational cohort study based
on administrative databases from 4 local health units was conducted.
Patients with a diagnosis of schizophrenia with a first
prescription of LA-risperidone between January 1, 2007 and
December 31, 2008 and a previous treatment with oral antipsychotics
were enrolled. Direct medical costs (drugs, hospitalizations,
Department of Mental Health services, outpatient specialist
services) were evaluated during the 12 months preceding
and following the date of inclusion (Fig. 1).
Results
A total of 157 patients were enrolled, 85 males and 72 females,
aged 46 ± 14 years (Table I). Total mean disease-related costs
per patient were € 5942.54 during the period preceding LArisperidone
and € 5385.88 after switching (-€ 556.66, -9.4%)
(Table III). The cost increase for antipsychotic drugs (from
€ 401.78 to € 2356.30, p < 0.001) was offset by a cost reduction
for assisted-living (from € 287.61 to € 236.49, p = 0.573),
congregate housing (from € 2113.38 to € 1132.48, p = 0.007),
Department of Mental Health services (from € 300.30 to
€ 278.33, p = 0.555) and hospitalizations (from € 2767.26 to
€ 1313.30, p < 0.001); we registered a decrease in hospital
mean length of stay (from 10.6 days to 4.6, p < 0.001) and
the number of hospitalizations per patient (from 0.70 to 0.37,
p < 0.001); 44% patients were hospitalized during the period
preceding LA-risperidone and 20% after switching (Table II).
The costs for services unrelated to schizophrenia showed no
significant differences (from € 439.54 to € 518.28). The level
of treatment adherence increased from 36.4% ± 30.5% to
61.4% ± 30.1% (Fig. 2).
Conclusions
Therapy with LA-risperidone appears to be cost saving, especially
considering the reduction in costs of hospitalizations due
to increased adherence.
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