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Thaman P, Kulig CE, Greer D. Efficacy of Long-Acting Injectable Antipsychotics Versus Oral Antipsychotics in Preventing Psychiatric Rehospitalizations. J Clin Psychopharmacol 2024; 44:96-99. [PMID: 38227617 DOI: 10.1097/jcp.0000000000001810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
PURPOSE/BACKGROUND Schizophrenia is a chronic, debilitating mental illness that incurs a large economic burden. Decreasing hospital readmissions is a priority in health care to improve patient quality of life and decrease health care costs. Determining ways to prevent readmissions such as improving access to long-acting injectable (LAI) antipsychotics is important to assess. METHODS/PROCEDURES A single-center retrospective review was conducted comparing readmission rates of patients diagnosed with schizophrenia or schizoaffective disorder discharged on LAI or oral antipsychotics between August 1, 2019, and June 30, 2022. The primary outcome was the 30-day psychiatric readmission rate. Secondary outcomes included chlorpromazine equivalent doses and use of anticholinergic medications. FINDINGS/RESULTS The 30-day readmission rate was 1.9% for the LAI antipsychotic group and 8.3% for the oral antipsychotic group ( P = 0.03; 95% confidence interval, 1.05-20.02). The average chlorpromazine equivalent antipsychotic dose of patients discharged on LAI versus oral antipsychotic medications was 477.3 and 278.6 mg/d, respectively ( P < 0.001). In addition, the prevalence of medications used to treat extrapyramidal symptom was 22.3% (n = 23) for the LAI antipsychotic group and 30.8% (n = 74) for the oral antipsychotic group ( P = 0.12). Sixty-four percent of LAI antipsychotics utilized were obtained from pharmaceutical company hospital inpatient free trial programs. IMPLICATIONS/CONCLUSIONS Long-acting injectable antipsychotics showed a statistically significant reduction in 30-day rehospitalizations as compared with oral antipsychotics and hospital inpatient free trial programs aided in LAI antipsychotic acquisition.
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Affiliation(s)
| | - Caitlin E Kulig
- Rutgers University Ernest Mario School of Pharmacy, Piscataway, NJ
| | - Daniel Greer
- Rutgers University Ernest Mario School of Pharmacy, Piscataway, NJ
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2
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Zhdanava M, Starr HL, Lefebvre P, Totev TI, Shah A, Sheng K, Pilon D. Understanding the Health System Conditions Affecting the Use of Long-Acting Injectable Antipsychotics in the Treatment of Schizophrenia in Clinical Practice: A US Healthcare Provider Survey. Neuropsychiatr Dis Treat 2022; 18:1479-1493. [PMID: 35910684 PMCID: PMC9326898 DOI: 10.2147/ndt.s369494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To describe factors that enable the routine use of long-acting injectable antipsychotics (LAIs) for appropriate patients in the current clinical practice, including changes in LAI prescribing due to the COVID-19 pandemic and expectations for prescribing in 2021 in the United States (US). METHODS Frequent LAI prescribers recruited from a nationwide panel in 2020 completed an online survey regarding practice characteristics, perspectives on healthcare system conditions enabling routine use of LAIs, and prescribing patterns and changes in patterns during the COVID-19 pandemic. RESULTS Of 408 prescribers who completed the survey, 77.7% were physicians and 59.1% had ≥10 years of psychiatry practice. More than half of frequent prescribers (57.1%) reported treating >20% of their patients with schizophrenia with LAIs. The American Psychiatric Association (APA) guideline was followed by 64.0% of prescribers. Most prescribers identified poor adherence to antipsychotics as a circumstance when LAIs are recommended (94.9%) and patient/caregiver involvement in treatment decisions as a key factor impacting the decision to prescribe LAIs (97.3%). Most prescribers reported that LAI prescribing rates were unchanged in 2020 (59.8%). Similar proportions of prescribers expected no change (44.1%) or an increase (42.9%) in LAI prescribing rates in 2021. The number of patients followed, cost of treatment, and availability of staff to administer LAIs were the main driving factors identified by prescribers expecting an increase in LAI prescribing rates. CONCLUSION LAIs were commonly recommended to patients with poor adherence, and patient/caregiver involvement was an important factor affecting prescribers' treatment decisions. LAI prescribing rates remained unchanged during the COVID-19 pandemic in 2020.
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Affiliation(s)
| | - H Lynn Starr
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | | | | | - Aditi Shah
- Analysis Group, Inc, Montréal, Quebec, Canada
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3
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Montemagni C, Del Favero E, Cocuzza E, Vischia F, Rocca P. Effect of long-acting injectable antipsychotics on hospitalizations and global functioning in schizophrenia: a naturalistic mirror-image study. Ther Adv Psychopharmacol 2022; 12:20451253221122526. [PMID: 36226272 PMCID: PMC9549097 DOI: 10.1177/20451253221122526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/31/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Partial adherence to antipsychotics is the most common cause of relapses and rehospitalization in patients with schizophrenia (SZ), leading to higher health care costs and psychosocial disability. The use of long-acting injectable (LAI) antipsychotics may improve therapeutic continuity and adherence to treatment. OBJECTIVE To assess the effectiveness of switching from oral antipsychotics (OAs) to long-acting antipsychotics. METHODS This 1-year mirror-image study evaluated the effect of switching from OAs to LAIs on the reduction of psychiatric hospitalizations and the improvement of global functioning in patients with schizophrenia. Differences in outcomes between second-generation (SGA) LAIs and first-generation (FGA) LAIs were also analyzed. RESULTS In all, 166 patients were included: 32.5% treated by FGA-LAIs and 67.5% by SGA-LAIs. There was an overall reduction of 71% in the average number of hospital admissions and an overall improvement of 29.3% in the Global Assessment of Functioning (GAF) score between the previous 12 months and the 12 months following the switching to LAIs. Patients who switched to SGA-LAIs had no significant differences in hospitalization occurrences but a significant improvement in GAF scores when compared with patients who switched to FGA-LAIs. CONCLUSION Our results suggest that using LAIs could be the most adequate treatment choice for SZ patients with a high risk of relapse and low adherence rate. Patients with poorer social functioning may be ideal candidates for SGA-LAIs treatment. Our findings may be of particular interest from a clinical and health care management perspective.
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Affiliation(s)
- Cristiana Montemagni
- Department of Neuroscience 'Rita Levi Montalcini', University of Turin, AOU Città della Salute e della Scienza, Via Cherasco N. 15, 10126 Turin, Italy
| | - Elisa Del Favero
- Department of Neuroscience 'Rita Levi Montalcini', University of Turin, Turin, Italy
| | - Elena Cocuzza
- Department of Mental Health, Azienda Sanitaria Locale (ASL) Città di Torino, Turin, Italy
| | - Flavio Vischia
- Department of Mental Health, Azienda Sanitaria Locale (ASL) Città di Torino, Turin, Italy
| | - Paola Rocca
- Department of Neuroscience 'Rita Levi Montalcini', University of Turin, Turin, Italy
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Takács P, Kunovszki P, Timtschenko V, Fehér L, Balázs T, Hegyi R, Czobor P, Bitter I. Comparative Effectiveness of Second Generation Long-acting Injectable Antipsychotics Based on Nationwide Database Research in Hungary: An Update. SCHIZOPHRENIA BULLETIN OPEN 2022; 3:sgac013. [PMID: 39144770 PMCID: PMC11205877 DOI: 10.1093/schizbullopen/sgac013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
Greater 1-year and 2-year treatment continuation rates and longer median time to discontinuation for second-generation antipsychotic (SGA) long-acting injectables (LAIs) vs oral antipsychotics (OAPs) in Hungary were previously reported. This study reports an updated comparison between new LAIs vs OAPs in Hungary. De-identified claims data from Hungarian National Health Insurance Fund database of schizophrenia patients who were newly initiated on SGAs (November 01, 2016 to June 30, 2017) were retrospectively analyzed. Primary outcomes were likelihood of all-cause 1-year and 1.5-year discontinuation of newly initiated SGA and median time till discontinuation. Among 5400 patients, 3977 (73.6%) were OAP users and 1423 (26.4%) were LAI users. The 1-year continuation rate were 12.7% (risperidone)-34.1% (olanzapine) for OAPs and 26.4% (risperidone LAI)-78.6% (paliperidone 3-monthly [PP3M]) for LAIs. The 1.5-year continuation rates were 9.3%-29.5% for OAPs and 24.9%-76.4% for LAIs. Median (95% CI) time to discontinuation was 52 (33-67) days (clozapine)-152 (134-168) days (aripiprazole) for OAPs and 125 (64-196) days (risperidone LAI)-491 (250-not reached) days (aripiprazole LAI) for LAIs. All-cause discontinuation risk was significantly higher in all OAPs vs PP3M and aripiprazole LAI (P < .01) as well as in each LAI vs PP3M (P < .05). Patients switching on new LAIs from another LAI remained longer than those who switched from OAPs/no previous treatment. Results showed the advantage of LAIs over OAPs in terms of time to treatment discontinuation. Moreover, new SGA LAIs (PP3M) seem to be better than previous LAIs in terms of time to treatment discontinuation.
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Affiliation(s)
| | | | - Valeria Timtschenko
- Health Economics, Market Access, & Reimbursement, Janssen Cilag, Neuss, Germany
| | | | | | | | - Pál Czobor
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - István Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
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Lee S, Schwartz S. Adherence and persistence to long-acting injectable dopamine receptor blocking agent therapy in the United States: A systematic review and meta-analysis of cohort studies. Psychiatry Res 2021; 306:114277. [PMID: 34808495 DOI: 10.1016/j.psychres.2021.114277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/25/2021] [Accepted: 11/06/2021] [Indexed: 01/24/2023]
Abstract
The purpose of this systematic review and meta-analysis was to assess adherence and persistence to long-acting injectable dopamine receptor blocking agents (LAI DRBAs) in published observational cohort studies conducted in the United States. Adherence rate (proportion of days covered ≥80%) and persistence rate (no gap in therapy ≥60 days) to LAI DRBAs were examined in 26 articles for qualitative review and 8 articles for quantitative review. There was significant variability in adherence and persistence rates to LAI DRBAs in the reported observational cohort studies. The mean adherence and persistence rates to LAI DRBAs in the included studies were 36% (8-66%) and 56% (32-80%), respectively. The use of LAI DRBAs showed cumulative benefit of achieving adherence 1.40 times higher compared to oral agents. The persistence rate was measured by number of patients having no more than 60 days gap in therapy at follow-up, and the cumulative benefit of being persistently on the therapy was 1.65 times higher among the LAI agents-exposed group compared to the oral agents-exposed group. The use of LAI DRBAs confers benefit in adherence and persistence compared to oral DRBA formulations.
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Affiliation(s)
- Sun Lee
- Department of Clinical Sciences, High Point University Fred Wilson School of Pharmacy, High Point, NC, USA
| | - Shaina Schwartz
- Department of Clinical Sciences, High Point University Fred Wilson School of Pharmacy, High Point, NC, USA.
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DEVRİMCİ ÖZGÜVEN H, KIR Y. Long Acting Injectable Antipsychotics in the Treatment of Schizophrenia and Bipolar Disorder. Noro Psikiyatr Ars 2021; 58:S47-S52. [PMID: 34658635 PMCID: PMC8498817 DOI: 10.29399/npa.27480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 05/21/2021] [Indexed: 11/23/2022] Open
Abstract
Schizophrenia and bipolar disorder (BD) are psychiatric disorders with economic and social effects that cause disability. Treatment non-compliance is one of the major problems faced by clinicians in both schizophrenia and BD. Treatment non-compliance is associated with recurrence and impaired functionality. Treatment compliance increases with long-acting injectable antipsychotics (LAIAs) and recurrence times are prolonged, hospitalization rates decrease compared to those who use an equivalent oral form of the same drug. The use of LAIAs in the maintenance treatment of schizophrenia has also been associated with a low mortality rate, decrease in caregiver burden, and increase in patient satisfaction. Studies show that LAIAs are cost-effective compared to their oral forms. Data on the use of LAIAs in first-episode schizophrenia and BD are relatively limited. The results of studies on the use of LAIAs in patients with first-episode schizophrenia indicate that LAIAs have advantageous in preventing relapse and re-hospitalization compared to oral antipsychotics. In BD, with the use of LAIAs, the rate of hospitalization due to mood episodes and the frequency of manic episodes have been decreased. LAIAs have not been found to be as effective in preventing depressive episodes in BD as manic episodes. Although there are many studies supporting the use of LAIAs in maintenance treatment of schizophrenia and BD, more studies are needed on this issue. In this article, studies on the use of LAIAs in schizophrenia, first episode schizophrenia and BD are reviewed and the place of LAIAs in treatment was discussed.
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Affiliation(s)
- Halise DEVRİMCİ ÖZGÜVEN
- Ankara University School of Medicine, Department of Psychiatry, Ankara University Institute of Health Sciences Department of Neuroscience, Ankara University Brain Research Center, Ankara, Türkiye
| | - Yağmur KIR
- Amasya University Sabuncuoğlu Şerefeddin Training and Research Hospital, Department of Mental Health and Diseases, Amasya, Turkey
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Velligan DI, Sajatovic M, Sierra C, Mintz J, Merker JM, Cassidy KA, Runnels P. A Program to Increase the Appropriate Use of Long-Acting Injectable Antipsychotic Medications in Community Settings. Psychiatr Serv 2021; 72:1012-1017. [PMID: 34018816 DOI: 10.1176/appi.ps.201900545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The Multilevel Facilitation of Long-Acting Antipsychotic Medication Program (MAP) is a novel intervention to increase the appropriate use of long-acting injectable (LAI) antipsychotics in community mental health clinics. The authors investigated the feasibility of MAP, facilitators and barriers to use, and preliminary impact on LAI medication use. METHODS Two clinics in Texas and two in Ohio serving 750 and 617 individuals with schizophrenia receiving oral antipsychotics, respectively, were asked to change clinical procedures for 1 year by using either the not receiving optimum benefit (NOB) checklist or the checklist plus MAP. Providers used the NOB checklist to identify individuals who could benefit from switching to LAI antipsychotics. MAP clinics used the NOB checklist plus nonbranded academic detailing for providers and a shared-decision-making video and tool for consumers. Use of MAP components was tracked, and barriers and facilitators were collected quarterly. Antipsychotic prescription counts were provided by participating clinics. RESULTS Barriers to use of MAP included loss of local champions and administrators, difficulty with provider buy-in, limited availability of peer specialists, and a lack of infrastructural support to integrate MAP into clinic flow. Higher scores on the NOB checklist were associated with more provider LAI medication offers and greater patient acceptance of LAI antipsychotics. LAI medication use increased in clinics over time, but it is unclear whether this increase was due to MAP. CONCLUSIONS Changing MAP components to fit local procedures and to circumvent unique barriers could aid implementation. Further research should investigate the potential impact of MAP components on LAI medication use.
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Affiliation(s)
- Dawn I Velligan
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio (Velligan, Sierra, Mintz); Department of Neurology (Sajatovic) and Department of Psychiatry (Sajatovic, Cassidy, Runnels), Case Western Reserve University School of Medicine, Cleveland; Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland (Sajatovic, Cassidy, Runnels); The Centers for Families and Children, Circle Health Services, Cleveland (Merker)
| | - Martha Sajatovic
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio (Velligan, Sierra, Mintz); Department of Neurology (Sajatovic) and Department of Psychiatry (Sajatovic, Cassidy, Runnels), Case Western Reserve University School of Medicine, Cleveland; Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland (Sajatovic, Cassidy, Runnels); The Centers for Families and Children, Circle Health Services, Cleveland (Merker)
| | - Cynthia Sierra
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio (Velligan, Sierra, Mintz); Department of Neurology (Sajatovic) and Department of Psychiatry (Sajatovic, Cassidy, Runnels), Case Western Reserve University School of Medicine, Cleveland; Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland (Sajatovic, Cassidy, Runnels); The Centers for Families and Children, Circle Health Services, Cleveland (Merker)
| | - Jim Mintz
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio (Velligan, Sierra, Mintz); Department of Neurology (Sajatovic) and Department of Psychiatry (Sajatovic, Cassidy, Runnels), Case Western Reserve University School of Medicine, Cleveland; Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland (Sajatovic, Cassidy, Runnels); The Centers for Families and Children, Circle Health Services, Cleveland (Merker)
| | - Julie M Merker
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio (Velligan, Sierra, Mintz); Department of Neurology (Sajatovic) and Department of Psychiatry (Sajatovic, Cassidy, Runnels), Case Western Reserve University School of Medicine, Cleveland; Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland (Sajatovic, Cassidy, Runnels); The Centers for Families and Children, Circle Health Services, Cleveland (Merker)
| | - Kristin A Cassidy
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio (Velligan, Sierra, Mintz); Department of Neurology (Sajatovic) and Department of Psychiatry (Sajatovic, Cassidy, Runnels), Case Western Reserve University School of Medicine, Cleveland; Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland (Sajatovic, Cassidy, Runnels); The Centers for Families and Children, Circle Health Services, Cleveland (Merker)
| | - Patrick Runnels
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio (Velligan, Sierra, Mintz); Department of Neurology (Sajatovic) and Department of Psychiatry (Sajatovic, Cassidy, Runnels), Case Western Reserve University School of Medicine, Cleveland; Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland (Sajatovic, Cassidy, Runnels); The Centers for Families and Children, Circle Health Services, Cleveland (Merker)
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Lo WA, Ki‐Yan Mak D, Ming‐Cheuk Wong M, Chan O, Mo‐Ching Chui E, Wai‐Sau Chung D, Suk‐Han Ip G, Lau K, Lee C, Mui J, Tam K, Tse S, Wong K. Achieving better outcomes for schizophrenia patients in Hong Kong: Strategies for improving treatment adherence. CNS Neurosci Ther 2021; 27 Suppl 1:12-19. [PMID: 33555616 PMCID: PMC7869929 DOI: 10.1111/cns.13375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Recent research on second-generation long-acting injectable antipsychotics (LAI SGAs) has proven its effectiveness in minimizing medication nonadherence problem and reducing relapses. Administered by medical professionals, making quick detection of nonadherence possible, long-acting injectable antipsychotics (LAIs) facilitate immediate intervention and recovery process, and thus are favored by psychiatrists. Despite a higher initial cost with LAIs, the subsequent schizophrenia-related health costs for hospitalizations and outpatients are greatly reduced. With reference to guidelines published by psychiatric associations around the globe, this article looks at scenarios in Hong Kong on the management of severe mentally ill patients with regard to the use of a host of psychosocial interventions as well as LAI SGAs as a preferable treatment. In particular, it examines the benefits of using LAI SGAs for Hong Kong patients who demonstrated high nonadherence treatment rates due to their social environment. It assesses the rationale behind the early usages of LAI SGAs, which help to provide better recovery outcomes for patients.
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Affiliation(s)
| | | | | | - Oi‐Wah Chan
- New Territories East Cluster (NTEC)Hong KongChina
| | - Eileena Mo‐Ching Chui
- Department of Social Work and Social AdministrationThe University of Hong KongHong KongChina
| | | | | | - Ka‐Shing Lau
- Hong Kong Society of Professional TrainingHong KongChina
| | - Che‐Kin Lee
- Department of PsychiatryThe Chinese University of Hong KongHong KongChina
| | - Jolene Mui
- Department of PsychiatryCastle Peak HospitalHong KongChina
| | | | - Samson Tse
- Department of Social Work and Social AdministrationThe University of Hong KongHong KongChina
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Palomar-Ciria N, Migoya-Borja M, Cegla-Schvartzman F, Ovejero S, Alvarez-Garcia R, Bello HJ, Baca-García E. Early administration of aripiprazole long-acting injectable in acute inpatients with schizophrenia: a clinical report. Int Clin Psychopharmacol 2021; 36:97-100. [PMID: 33492014 DOI: 10.1097/yic.0000000000000345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Fifty-one patients suffering an acute episode of schizophrenia and treated with aripiprazole long-acting injectable (ALAI) were chosen to elaborate an observational study in two in-patient units in Spain, in order to examine the effects of early administration during a hospital admission. When treatment with ALAI is administered in the first week of admission (in 31 patients, 60.78%), hospitalization time is significantly reduced, 12.1 days on average. It can be concluded that ALAI is an effective treatment for these patients. Analysis in economic terms and comparison with other LAI antipsychotics are interesting lines for further research.
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Affiliation(s)
| | | | | | | | | | - Hugo J Bello
- Department of Applied Mathematics, Universidad de Valladolid, Soria
| | - Enrique Baca-García
- Department of Psychiatry, Jiménez Díaz Foundation
- Department of Psychiatry, Rey Juan Carlos Hospital, Móstoles, Madrid
- Universidad Autónoma de Madrid, Facultad de Medicina
- Insituto de Investigación Sanitaria Fundación Jiménez Díaz
- Department of Psychiatry, General Hospital of Villalba, Villalba
- Department of Psychiatry, University Hospital Infanta Elena, Valdemoro
- CIBERSAM (Centro de Investigación en Salud Mental), Carlos III Institute of Health, Madrid, Spain
- Universidad Católica del Maule, Talca, Chile
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10
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Persistent Barriers to the Use of Long-Acting Injectable Antipsychotics for the Treatment of Schizophrenia. J Clin Psychopharmacol 2021; 40:346-349. [PMID: 32639287 DOI: 10.1097/jcp.0000000000001225] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE/BACKGROUND One of the major challenges in the treatment of schizophrenia is nonadherence, defined as the failure to take medications as prescribed. Nonadherence is a strong predictor of symptom relapse, hospital readmission, and poorer long-term outcome. Although long-acting injectable antipsychotics (LAIs) have been found to be superior to their oral analogs at reducing relapse in large-scale meta-analyses, their prevalence seldom exceeds 30% even in populations with a history of nonadherence. We review multiple barriers to the use of LAI utilization and suggest strategies to address them. METHODS/PROCEDURES We searched for the following terms: long-acting injectable/depot antipsychotics, schizophrenia, barriers, and attitude/perception in both the PubMed search index and Google scholar from 1995 to 2018. A total of 329 studies were selected, of which data from 13 were reviewed for this article. Only peer-reviewed studies, randomized controlled trials, systematic reviews, and meta-analyses that describe barriers to using LAIs were included. FINDINGS/RESULTS Several barriers to using LAIs were identified. These are organized into 3 overarching categories: those related to the clinician; those related to the patient; and systems barriers. Clinician factors include the perception of LAIs as coercive, fears of not being able to control the dose, as well as current practice patterns and guidelines. Patient factors include perception of the injection as painful or intrusive, general lack of knowledge, and a sense of coerciveness. For each identified barrier, we propose potential solutions. IMPLICATIONS/CONCLUSIONS We identified multiple barriers to using LAIs in patients with schizophrenia. Specific strategies are suggested for overcoming each of these barriers.
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Kimura H, Kanahara N, Iyo M. Rationale and neurobiological effects of treatment with antipsychotics in patients with chronic schizophrenia considering dopamine supersensitivity. Behav Brain Res 2021; 403:113126. [PMID: 33460681 DOI: 10.1016/j.bbr.2021.113126] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/29/2020] [Accepted: 01/04/2021] [Indexed: 12/12/2022]
Abstract
The long-term treatment of patients with schizophrenia often involves the management of relapses for most patients and the development of treatment resistance in some patients. To stabilize the clinical course and allow as many patients as possible to recover, clinicians need to recognize dopamine supersensitivity, which can be provoked by administration of high dosages of antipsychotics, and deal with it properly. However, no treatment guidelines have addressed this issue. The present review summarized the characteristics of long-acting injectable antipsychotics, dopamine partial agonists, and clozapine in relation to dopamine supersensitivity from the viewpoints of receptor profiles and pharmacokinetics. The potential merits and limitations of these medicines are discussed, as well as the risks of treating patients with established dopamine supersensitivity with these classes of drugs. Finally, the review discussed the biological influence of antipsychotic treatment on the human brain based on findings regarding the relationship between the hippocampus and antipsychotics.
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Affiliation(s)
- Hiroshi Kimura
- Department of Psychiatry, School of Medicine, International University of Health and Welfare, Chiba, Japan; Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan; Department of Psychiatry, Gakuji-kai Kimura Hospital, Chiba, Japan.
| | - Nobuhisa Kanahara
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan; Division of Medical Treatment and Rehabilitation, Chiba University Center for Forensic Mental Health, Chiba, Japan
| | - Masaomi Iyo
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
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Lin D, Thompson-Leduc P, Ghelerter I, Nguyen H, Lafeuille MH, Benson C, Mavros P, Lefebvre P. Real-World Evidence of the Clinical and Economic Impact of Long-Acting Injectable Versus Oral Antipsychotics Among Patients with Schizophrenia in the United States: A Systematic Review and Meta-Analysis. CNS Drugs 2021; 35:469-481. [PMID: 33909272 PMCID: PMC8144083 DOI: 10.1007/s40263-021-00815-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Long-acting injectable (LAI) antipsychotics, compared with oral antipsychotics (OA), have been found to significantly improve patient outcomes, including reduced hospitalizations and emergency room (ER) admissions and increased medication adherence among adult patients with schizophrenia. In turn, the clinical benefits achieved may translate into lower economic burden. Real-world evidence of the comparative effectiveness of LAI is needed to understand the potential benefits of LAI outside of the context of clinical trials. This study aimed to provide a comprehensive synthesis of recent published real-world studies comparing healthcare utilization, costs, and adherence between patients with schizophrenia treated with LAI versus OA in the United States. METHODS In this systematic literature review, MEDLINE® was searched for peer-reviewed, real-world studies (i.e., retrospective or pragmatic designs) published in English between January 1, 2010 and February 10, 2020. Comparative studies reporting hospitalizations, ER admissions, healthcare costs, or medication adherence (measured by proportion of days covered [PDC]) in adults with schizophrenia treated with LAI versus OA (or pre- vs post-LAI initiation) in the United States were retained. Random effects meta-analyses were conducted among eligible studies to evaluate the association of LAI versus OA use on hospitalizations, ER admissions, healthcare costs, and treatment adherence. A sensitivity analysis among the subset of studies that compared OA with paliperidone palmitate once monthly (PP1M), specifically, was conducted. RESULTS A total of 1083 articles were identified by the electronic literature search, and two publications were manually added subsequently. Among the 57 publications meeting the inclusion criteria, 25 provided sufficient information for inclusion in the meta-analyses. Compared with patients treated with OA, patients initiated on LAI had lower odds of hospitalization (odds ratio [OR] 0.62, 95% confidence interval [CI] 0.54-0.71, n = 7), fewer hospitalizations (incidence rate ratio [IRR] [95% CI] 0.75 [0.65-0.88], n = 9), and fewer ER admissions (IRR [95% CI] 0.86 [0.77-0.97], n = 6). The initiation of LAI was associated with higher per-patient-per-year (PPPY) pharmacy costs (mean difference [MD] [95% CI] $5603 [3799-7407], n = 6), which was offset by lower PPPY medical costs (MD [95% CI] - $5404 [- 7745 to - 3064], n = 6), resulting in no significant net difference in PPPY total all-cause healthcare costs between patients treated with LAI and those treated with OA (MD [95% CI] $327 [- 1565 to 2219], n = 7). Patients initiated on LAI also had higher odds of being adherent to their medication (PDC ≥ 80%; OR [95% CI] 1.89 [1.52-2.35], n = 9). A sensitivity analysis on a subset of publications evaluating PP1M found results similar to those of the main analysis conducted at the LAI class level. CONCLUSIONS Based on multiple studies with varying sub-types of patient populations with schizophrenia in the United States published in the last decade, this meta-analysis demonstrated that LAI antipsychotics were associated with improved medication adherence and significant clinical benefit such as reduced hospitalizations and ER admissions compared with OA. The lower medical costs offset the higher pharmacy costs, resulting in a non-significant difference in total healthcare costs. Taken together, these findings provide strong evidence on the clinical and economic benefits of LAI compared with OA for the treatment of schizophrenia in the real world.
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Affiliation(s)
- Dee Lin
- Janssen Scientific Affairs, LLC, Titusville, NJ USA
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Time to Treatment Discontinuation in German Patients with Schizophrenia: Long-Acting Injectables versus Oral Antipsychotics. Clin Drug Investig 2020; 41:99-113. [PMID: 33331979 PMCID: PMC7815621 DOI: 10.1007/s40261-020-00990-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 12/03/2022]
Abstract
Background and Objective Long-acting injectable antipsychotics (LAIs) are associated with better treatment adherence and persistence than oral antipsychotics (OAPs) in patients with schizophrenia. However, real-world evidence assessing the impact of treatment with LAIs in Germany is limited. To fill this gap, we compared antipsychotic medication adherence and risk of treatment discontinuation (TD) among schizophrenia patients newly initiated on LAI or who switched their OAP regimen (overall cohort; OC). Methods Claims data of German schizophrenia patients who initiated LAIs or switched their OAP during 2012–2016 (index date) were retrospectively analyzed. Treatment switch was defined as add-on medication to existing prescription or terminating the existing prescription and initiating another OAP. Adherence and time to treatment discontinuation (TTD) were estimated. Determinants of treatment discontinuation were analyzed using two Cox regression models. Model 1 controlled for age, sex, and Charlson Comorbidity Index (CCI); model 2 also included insurance status, and medication, visit, and psychiatric inpatient stay costs. Sensitivity analysis on patients who terminated existing prescriptions and initiated new OAPs (complete switch cohort; CSC) was performed. Results In OC (n = 2650), LAI users had better adherence (35.4% vs. 11.6%), persistence (no 60-day gap; 40.7% vs. 19.8%), and longer TTD (median [95% confidence interval (CI)] 216 [193–249] vs. 50 [46–56] days) than OAP users. OAP usage (hazard ratio [HR] 1.89, 95% CI 1.73–2.06; p < 0.001) and greater CCI (HR 1.04, 95% CI 1.00–1.07; p = 0.023) were associated with greater risk of TD in model 1. Model 2 showed similar results. LAI users in CSC also had better adherence, persistence, and longer TTD. In CSC too, OAP usage and greater CCI were associated with greater risk of TD in model 1, but only CCI was significant in model 2. Higher pre-index psychiatric inpatient costs were associated with lower risk of TD (HR 0.99, 95% CI 0.98–1.00; p = 0.014). Limitations Inherent limitations of claims data and lack of control on OAP administration may have influenced the results. Conclusion This real-world study associates LAIs with better medication adherence and lower antipsychotic discontinuation risk than OAPs. Supplementary Information The online version contains supplementary material available at 10.1007/s40261-020-00990-8.
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Patel C, Khoury AE, Huang A, Wang L, Bashyal R. Healthcare Resource Utilization and Costs Among Patients With Schizophrenia Switching From Oral Risperidone/Paliperidone to Once-Monthly Paliperidone Palmitate: A Veterans Health Administration Claims Analysis. Curr Ther Res Clin Exp 2020; 92:100587. [PMID: 32714469 PMCID: PMC7378858 DOI: 10.1016/j.curtheres.2020.100587] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 04/08/2020] [Indexed: 11/29/2022] Open
Abstract
Background Schizophrenia is associated with high health care resource utilization and treatment costs. Objective This study compared treatment patterns, health care resource utilization, and medical costs before and after a switch from oral antipsychotic drug (risperidone or paliperidone [RIS/PALI]) therapy to the long-acting injectable once-monthly paliperidone palmitate (PP1M) in patients with schizophrenia. Methods Data for adult patients (aged ≥18 years) with at least 1 diagnosis of schizophrenia who initiated treatment with oral RIS/PALI ≥6 months before switching and had continuous health plan enrollment during the study period before and after the switch were extracted from the Veterans Health Administration database. Treatment patterns, health care resource utilization, and costs were compared between the period 6 or 12 months before and after switching directly from oral RIS/PALI to PP1M. Results The analysis included 676 and 493 patients in the 6-month and 12-month cohorts, respectively. Adherence to oral RIS/PALI during the 12 months preswitch was 11.0% and 22.1% as measured by proportion of days covered and medication possession ratio ≥80%, respectively. During the 12 months postswitch, adherence to PP1M was 27.0% and 35.9%, respectively. Among patients treated with oral RIS/PALI, from 12 months pre- to 12 months post-PP1M switch, fewer all-cause inpatient stays (2.2 vs 1.1, respectively; P < 0.05) and a shorter mean length of inpatient stay (28.1 and 14.0 days, respectively; P < 0.05) were observed. This pattern was similar for both the number of mental health– and schizophrenia-related inpatient stays and length of stay. Compared with 12 months pre-PP1M switch, significantly higher mean numbers of all-cause outpatient visits and pharmacy visits were observed at 12 months postswitch. In line with health care resource utilization findings, at 12 months pre- versus 12 months post-PP1M switch we observed decreases in all-cause inpatient stay costs ($41,886 vs $20,489; P < 0.05) and increases in outpatient visit costs ($22,005 vs $29,069; P < 0.05). Findings for the 6-month cohort followed a similar pattern. Conclusions Post-PP1M switch, a decrease in total medical costs fully offset an increase in pharmacy costs, resulting in similar total costs. The findings suggest potential economic benefits of switching patients with schizophrenia from oral RIS/PALI to PP1M in the Veterans Health Administration.
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Affiliation(s)
- Charmi Patel
- Janssen Scientific Affairs, LLC, Titusville, New Jersey
| | | | | | - Li Wang
- STATinMED Research, Plano, Texas
| | - Richa Bashyal
- STATinMED Research, Plano, Texas.,Current affiliation: University of Texas Southwestern Medical Center, Dallas, Texas
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15
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Yan T, Greene M, Chang E, Houle CR, Waters HC, Tarbox MH, Broder MS. Health Care Cost in Patients With Schizophrenia Treated With Brexpiprazole Versus Other Oral Atypical Antipsychotic Therapy. Clin Ther 2020; 42:77-93. [PMID: 31928831 DOI: 10.1016/j.clinthera.2019.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/29/2019] [Accepted: 11/14/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE Brexpiprazole is an oral atypical antipsychotic (OAA) for the treatment of schizophrenia (SCZ). This study compared all-cause and psychiatric inpatient hospitalization and medical costs in adult patients with SCZ newly treated with brexpiprazole versus other US Food and Drug Administration-approved OAAs in a real-world setting. METHODS This retrospective cohort study analyzed data from: (1) the IBM MarketScan Commercial and Medicare Supplemental databases, and the MarketScan Multi-State Medicaid database; and (2) the de-identified Optum Clinformatics Datamart. Adult patients were identified if they had SCZ and initiated either brexpiprazole or another OAA during the study identification period (July 1, 2015, to September 30, 2016, for MarketScan Commercial and Medicare Supplemental and for Optum; July 1, 2015, to June 30, 2016, for MarketScan Multi-State Medicaid) and had ≥12 months of continuous enrollment before (baseline) and after (follow-up) the first treatment date. Linear regression analyses were performed to test associations between treatment groups (brexpiprazole vs another OAA) and costs (total and medical); negative binomial regression models were used to estimate number of hospitalizations per year, adjusting for baseline characteristics and medication adherence to index treatment during the 12-month follow-up. FINDINGS The final study sample consisted of 6254 patients with SCZ: 176 initiated brexpiprazole; 391, ziprasidone; 453, paliperidone; 523, lurasidone; 786, aripiprazole; 1234, quetiapine; 1264, olanzapine; and 1427, risperidone. Controlling for baseline characteristics and medication adherence, the adjusted number of hospitalizations (both all-cause and psychiatric), all-cause total costs, and all-cause medical costs did not differ across groups. Brexpiprazole users had the lowest mean psychiatric costs among all OAA users ($12,013; 95% bootstrap CI, 7488-16,538). Compared with brexpiprazole users, paliperidone (incidence rate ratio [95% CI], 1.52 [1.05-2.19]; P = 0.027) and quetiapine (incidence rate ratio [95% CI], 1.47 [1.04-2.07]; P = 0.029) users had more psychiatric hospitalizations per year. Paliperidone had higher psychiatric costs than brexpiprazole (total, $32,066 [95% bootstrap CI, 28,779-35,353] vs $23,851 [18,907-28,795]; medical, $19,343 [16,294-22,392] vs $12,013 [7488-16,538]). Psychiatric medical costs were also $6744 higher in olanzapine users (95% bootstrap CI, 1694-11,795; P = 0.009) than in brexpiprazole users. IMPLICATIONS Patients with SCZ treated with brexpiprazole had fewer psychiatric hospitalizations and lower psychiatric costs than those treated with paliperidone. Differences in the number of all-cause hospitalizations and medical costs among treatments were not statistically significant. Although treatment decisions are driven by a number of factors (eg, clinical circumstances and drug costs), choice of OAA may affect health care costs.
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Affiliation(s)
- Tingjian Yan
- Partnership for Health Analytic Research, Beverly Hills, CA, USA.
| | - Mallik Greene
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, USA
| | - Eunice Chang
- Partnership for Health Analytic Research, Beverly Hills, CA, USA
| | | | - Heidi C Waters
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, USA
| | - Marian H Tarbox
- Partnership for Health Analytic Research, Beverly Hills, CA, USA
| | - Michael S Broder
- Partnership for Health Analytic Research, Beverly Hills, CA, USA
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Song X, El Khoury AC, Brouillette M, Smith D, Joshi K. Treatment discontinuation of long-acting injectables or oral atypical antipsychotics among Medicaid recipients with schizophrenia. J Med Econ 2019; 22:1105-1112. [PMID: 31062998 DOI: 10.1080/13696998.2019.1615927] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Aims: Among patients with schizophrenia, poor adherence and persistence with oral atypical antipsychotics (OAA) often results in relapse and hospitalization. Second-generation antipsychotic long-acting injectables (SGA LAI) have demonstrated higher adherence than first-generation antipsychotic LAI and OAA therapies. This study aimed to determine whether SGA LAIs are associated with better persistency compared to OAA among Medicaid recipients with schizophrenia. Materials and methods: From the MarketScan Medicaid Database (January 1, 2010-June 30, 2016), patients aged ≥18 years with schizophrenia and ≥2 pharmacy claims more than 90 days apart for the same SGA LAI or OAA were selected. New users of the specific antipsychotic agent were classified, based on their index agent, as: OAA, paliperidone palmitate LAI (PPLAI), aripiprazole LAI (ALAI), and risperidone LAI (RLAI). Discontinuation during 1 year of follow-up was defined as a ≥ 60-day gap in the index OAA or SGA LAI medication past the exhaustion of the previous claim's supply. Inverse probability of treatment weights (IPTW) balanced the cohort characteristics, and weight outliers (<0.1 or >0.9) were excluded. IPTW-weighted Cox proportional hazards regression estimated hazard ratios for discontinuation. Results: Cohorts included 7,029 OAA, 4,302 PPLAI, 586 ALAI, and 1,456 RLAI patients. Mean age was 38.0-41.0 years and 44.0-46.6% were female. Persistence was significantly longer in the SGA LAI cohorts than in the OAA cohort. Adjusted hazard ratios (95% confidence intervals) for discontinuation were 0.60 (0.56-0.64) for PPLAI, 0.69 (0.60-0.79) for ALAI, and 0.70 (0.64-0.77) for RLAI vs OAA. Limitations: Results may not be generalizable to patients covered by commercial or Medicare insurance, and limitations inherent to any claims-based retrospective analysis apply. Conclusions: SGA LAI may be a valuable option for treating schizophrenia given the improvement in persistence.
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Affiliation(s)
- Xue Song
- Oncology and Life Sciences, IBM Watson Health , Cambridge , MA , USA
| | - Antoine C El Khoury
- US Real World Value & Evidence, Janssen Pharmaceuticals, Inc , Titusville , NJ , USA
| | | | - David Smith
- Oncology and Life Sciences, IBM Watson Health , Cambridge , MA , USA
| | - Kruti Joshi
- US Real World Value & Evidence, Janssen Pharmaceuticals, Inc , Titusville , NJ , USA
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Mooney EV, Hamper JG, Willis RT, Farinha TL, Ricchetti CA. Evaluating patient satisfaction with pharmacist-administered long-acting injectable antipsychotics in the community pharmacy. J Am Pharm Assoc (2003) 2019; 58:S24-S29.e2. [PMID: 30006184 DOI: 10.1016/j.japh.2018.04.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 04/22/2018] [Accepted: 04/26/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate patient satisfaction with pharmacist-administered long-acting injectable antipsychotics (LAIAs) in the community pharmacy. DESIGN Prospective survey. SETTING Albertsons Companies community pharmacies during December 2016 to February 2017. PARTICIPANTS Patients receiving LAIAs at participating pharmacies. MAIN OUTCOME MEASURES A survey assessed patients' satisfaction with pharmacist-administered LAIAs in the community pharmacy. RESULTS LAIA recipients (N = 104) reported satisfaction with community pharmacist-administered LAIAs. Participants who had received the service at other types of health clinics (N = 57) also reported higher satisfaction with current service compared to a similar service received elsewhere. Participants indicated that they would recommend service to others and that service was more convenient than a similar service received in an alternative setting. There was not a statistically significant relationship between patient demographic characteristics and likelihood of recommending service to others. CONCLUSION Patients were satisfied with a pharmacist-administered LAIA service in the community pharmacy, and they found it more convenient than similar services provided elsewhere.
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Munday J, Greene M, Chang E, Hartry A, Yan T, Broder MS. Early initiation of long-acting injectable antipsychotic treatment is associated with lower hospitalization rates and healthcare costs in patients with schizophrenia: real-world evidence from US claims data. Curr Med Res Opin 2019; 35:1231-1239. [PMID: 30649965 DOI: 10.1080/03007995.2019.1571295] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective: Early initiation of antipsychotic treatment in schizophrenia is associated with improved outcomes. This study aimed to determine if initiation of long-acting injectable (LAI) antipsychotic treatment early in a new schizophrenia episode is associated with lower hospitalization rates and healthcare costs in a real-world setting. Methods: This retrospective (January 1, 2007-June 30, 2016) cohort analysis used claims from Truven Health Analytics MarketScan Commercial, Medicaid, and Medicare Supplemental databases. In adults ≥18 years with a new episode of schizophrenia, two mutually exclusive cohorts were identified based on time from first recorded schizophrenia diagnosis date to first date of LAI initiation (index date): ≤1 year (early initiators) and >1 year (late initiators). Logistic and general linear regression models were performed to estimate adjusted hospitalization rate and healthcare costs in a 1-year follow-up, controlling patient demographic and clinical characteristics, insurance type, baseline all-cause hospitalizations and ED visits, and baseline psychiatric medication use. Results: Of the subjects, 32% (n = 1388) initiated treatment early and 68% (n = 2978) initiated treatment later. In risk-adjusted models, all-cause hospitalization rates were 22.2% (95% CI = 19.9-24.6%) in early initiators and 26.9% (95% CI = 25.2-28.7%) in late initiators (p = .002). Of early initiators, 14.1% (95% CI = 12.3-16.1%) had a psychiatric hospitalization vs 19.2% (95% CI = 17.7-20.8%) of late initiators (p < .001). Adjusted psychiatric healthcare costs were significantly lower in early initiators compared with late initiators [mean (95% CI) = $21,545 (20,355-22,734) vs $24,132 (23,330-24,933)] (p < .001). Conclusions: LAI initiation within 1 year of a new schizophrenia episode led to lower hospitalization rates and healthcare costs compared with LAI initiation more than 1 year after a new episode.
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Affiliation(s)
- Jennifer Munday
- a Health Services Research , Partnership for Health Analytic Research, LLC , Beverly Hills , CA , USA
| | - Mallik Greene
- b Health Economics & Outcomes Research , Otsuka Pharmaceutical Development & Commercialization, Inc. , Princeton , NJ , USA
| | - Eunice Chang
- a Health Services Research , Partnership for Health Analytic Research, LLC , Beverly Hills , CA , USA
| | - Ann Hartry
- c Health Economics and Outcomes , Lundbeck, LLC , Deerfield , IL , USA
| | - Tingjian Yan
- a Health Services Research , Partnership for Health Analytic Research, LLC , Beverly Hills , CA , USA
| | - Michael S Broder
- a Health Services Research , Partnership for Health Analytic Research, LLC , Beverly Hills , CA , USA
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19
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Chiu LL, Liu CH, Chu CL, Lin HL, Lii SC. Patients' experiences of long-acting injectable antipsychotics: a qualitative study. Neuropsychiatr Dis Treat 2019; 15:1797-1804. [PMID: 31308672 PMCID: PMC6613361 DOI: 10.2147/ndt.s206154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 06/12/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In this study, we applied a qualitative approach to explore patients' subjective experiences of long-acting injectable antipsychotics (LAIs). METHODS Patients undergoing psychiatric treatment from the chronic ward or outpatient department of a medical center in northern Taiwan who had experience with LAI treatment were enrolled. Information was obtained through semi-structured in-depth interviews. The interviews were audio-recorded and then translated verbatim, and the data were collected and analyzed concurrently to develop major themes and categories. RESULT In total, 14 participants (8 female) were interviewed. In a bio-psycho-social model, the participants used LAIs as a method to become "normal," in order to achieve a balance between the "effects" and "side effects" that may influence their daily lives. Their past experiences constructed their concepts about and expectations regarding LAIs, and their relationships with their family members and co-workers also modeled their experiences. CONCLUSION In our study, we sought to understand the experience of LAI in the daily life context of the patients. We attempted to use a bio-psycho-social model to evaluate the subjective experience of the patients; an improved understanding can help mental health specialists gain a closer insight into patient experience.
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Affiliation(s)
- Lin-Ling Chiu
- School of Medicine, Collage of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Hao Liu
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Department of Child Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chun-Lin Chu
- Department of Psychiatry, Chang Gung Memorial Hospital at Taoyuan, Taoyuan, Taiwan
| | - Huang-Li Lin
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Shu-Chung Lii
- Humanistic & Social Medicine Division, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Potempa C, Rychlik R. Hospitalization rates and resource utilization of schizophrenic patients switched from oral antipsychotics to aripiprazole-depot in Germany. HEALTH ECONOMICS REVIEW 2018; 8:30. [PMID: 30470936 PMCID: PMC6755603 DOI: 10.1186/s13561-018-0215-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/16/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Examine cost-driving factors of schizophrenia in Germany for patients prior- and post-switch from an oral antipsychotic therapy to aripiprazole-depot and perform a budget impact analysis (BIA) referring to the context of German health care. METHODS A single-armed, retrospective, non-interventional pre-post comparison study with 132 patients to compare the total psychiatric hospitalization rates and the associated costs of both, the treatment with oral antipsychotics and aripiprazole-depot. The BIA was performed to compare both treatment periods with respect to health-related costs. A subsequent univariate sensitivity analysis examined the robustness of the results. RESULTS After switching the treatment to aripiprazole-depot, the total psychiatric hospitalization rates for the 6-month treatment period were significantly (p < 0.001) lower (14%) compared to the hospitalization rates when treated with oral antipsychotics (55.1%). 18.2% of the patients reported to be employed, with 29.2% having work incapacities. The mean number of schizophrenia episodes was 2.58 episodes per patient during the oral-antipsychotic treatment compared to 0.41 episodes per patient during the aripiprazole-depot phase (p < 0.001). The treatment with aripiprazole-depot also significantly reduced the mean number of hospitalizations per patient (0.63 to 0.16, p < 0.001) and the mean number of hospitalized days (27.39 to 5.56, p < 0.001) compared to the oral antipsychotic treatment. Additionally a significant reduction of the mean stay in day-clinics and psychiatric institute ambulances (PIAs) was observed (46.13 days to 7.29 days, p < 0.01). Treatment of a patient suffering from schizophrenia with oral antipsychotics produced costs of 9935.38€ (direct costs: 9498.36 €), while aripiprazole-depot generated costs of 4557.56€ (direct costs: 4449.83 €) per patient for a one-year observation period. This resulted in total costs of 6,517,606,265.43€ for the oral antipsychotic treatment and 2,989,756,603.05€ for aripiprazole-depot treatment from the perspective of the German health care system. The results remained robust during sensitivity analysis, with aripiprazole-depot being the more cost-effective strategy. CONCLUSIONS The results suggest that aripiprazole-depot treatment for schizophrenia patients has major potential in terms of cost savings for the German statutory health insurance.
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Affiliation(s)
- Christoph Potempa
- Institute of Empirical Health Economics, Am Ziegelfeld 28, 51399, Burscheid, Germany.
| | - Reinhard Rychlik
- Institute of Empirical Health Economics, Am Ziegelfeld 28, 51399, Burscheid, Germany
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Shah A, Xie L, Kariburyo F, Zhang Q, Gore M. Treatment Patterns, Healthcare Resource Utilization and Costs Among Schizophrenia Patients Treated with Long-Acting Injectable Versus Oral Antipsychotics. Adv Ther 2018; 35:1994-2014. [PMID: 30269292 DOI: 10.1007/s12325-018-0786-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Long-acting injectable (LAI) antipsychotic use may reduce healthcare resource utilization compared with oral antipsychotic use by improving adherence and reducing dosing frequency. Our goal was to examine treatment patterns, healthcare utilization, and costs among recently diagnosed schizophrenia patients receiving oral versus LAI antipsychotics. METHODS The MarketScan Multi-state Medicaid database was used to identify schizophrenia patients aged ≥ 18 years who received an LAI or oral antipsychotic between January 1, 2011 and December 31, 2014. Primary outcomes included treatment patterns such as adherence (measured as proportion of days covered-PDC), persistence, discontinuation, switching, and healthcare resource utilization and costs. Propensity score matching (PSM) was used to control for differences in baseline characteristics between the cohorts. Outcomes were assessed over a 12-month post-index period and compared between treatment cohorts. RESULTS After PSM, 2302 patients were included in each of the LAI and oral antipsychotics cohorts. There were no differences in PDC or therapy switching between the two cohorts. Compared with the oral cohort, patients receiving LAIs had lower discontinuation rates (46.1 vs. 61.6%, p < 0.001), fewer inpatient admissions (0.5 vs. 0.9, p < 0.001), hospital days (3.9 vs. 6.5, p < 0.001), and ER visits (2.4 vs. 2.9, p = 0.007), and a higher number of prescription fills (29.5 vs. 25.3, p < 0.001). Patients prescribed LAIs had lower monthly inpatient ($US4007 vs. 8769, p < 0.001) and ER visits costs ($682 vs. 891, p < 0.001) but higher monthly medication costs ($10,713 vs. $655, p < 0.001) compared with the oral cohort over the 12-month post-index period. Overall, both cohorts had similar total medical costs (LAI vs. oral: $24,988 vs. 23,887, p = 0.354) during the follow-up period. CONCLUSION Patients receiving LAIs were more likely to remain on medication compared with the oral group, which may account for reduced inpatient admissions. Hospitalization cost reductions offset the higher costs of LAI medications, resulting in no increase in total healthcare costs relative to oral antipsychotic use. FUNDING Alkermes Inc.
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Affiliation(s)
| | - Lin Xie
- STATinMED Research, Ann Arbor, MI, USA
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Shafrin J, Bognar K, Everson K, Brauer M, Lakdawalla DN, Forma FM. Does knowledge of patient non-compliance change prescribing behavior in the real world? A claims-based analysis of patients with serious mental illness. CLINICOECONOMICS AND OUTCOMES RESEARCH 2018; 10:573-585. [PMID: 30323635 PMCID: PMC6173173 DOI: 10.2147/ceor.s175877] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background New digital technologies offer providers the promise of more accurately tracking patients’ medication adherence. It is unclear, however, whether access to such information will affect provider treatment decisions in the real world. Methods Using prescriber-reported information on patient non-compliance from health insurance claims data between 2008 and 2014, we examined whether prescribers’ knowledge of non-compliance was associated with different prescribing patterns for patients with serious mental illness (SMI). We examined patients who initiated an oral atypical antipsychotic, but were later objectively non-adherent to this treatment, defined as proportion of days covered (PDC) <0.8. We examined how a physician’s awareness of patient non-compliance (ICD-9 diagnosis code: V15.81) was correlated with the physician’s real-world treatment decisions for that patient. Treatment decisions studied included the share of patients who increased antipsychotic dose, augmented treatment, switched their antipsychotic, or used a long-acting injectable (LAI). Results Among the 286,249 patients with SMI who initiated an antipsychotic and had PDC <0.8, 4,033 (1.4%) had documented non-compliance. When prescribers documented non-compliance, patients were more likely to be switched to another antipsychotic (32.8% vs 24.7%, P<0.001), have their dose increased (24.4% vs 22.1%, P=0.004), or receive an LAI (0.09% vs 0.04%, P=0.008), but were less likely to have augmented therapy with another antipsychotic (1.1% vs 1.3%, P=0.035) than patients without documented non-compliance. Conclusion Among SMI patients with documented non-compliance, the frequency of dose, medication switches, and LAI use were higher and augmentation was lower compared to patients without documented non-compliance. Access to adherence information may help prescribers more rapidly switch ineffective medications as well as avoid unnecessary medication augmentation.
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Affiliation(s)
- Jason Shafrin
- Policy and Economics, Precision Health Economics, Los Angeles, CA, USA,
| | - Katalin Bognar
- Policy and Economics, Precision Health Economics, Los Angeles, CA, USA,
| | - Katie Everson
- Policy and Economics, Precision Health Economics, Los Angeles, CA, USA,
| | - Michelle Brauer
- Policy and Economics, Precision Health Economics, Boston, MA, USA
| | - Darius N Lakdawalla
- School of Pharmacy, Sol Price School of Public Policy, Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
| | - Felicia M Forma
- Health Economics and Outcomes Management, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
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Ostuzzi G, Mazzi MA, Terlizzi S, Bertolini F, Aguglia A, Bartoli F, Bortolaso P, Callegari C, Caroleo M, Carrà G, Corbo M, D’Agostino A, Gastaldon C, Lucii C, Magliocco F, Martinotti G, Nosé M, Ostinelli EG, Papola D, Piccinelli MP, Piccoli A, Purgato M, Tabacchi T, Turrini G, Ruggeri M, Barbui C. Factors associated with first- versus second-generation long-acting antipsychotics prescribed under ordinary clinical practice in Italy. PLoS One 2018; 13:e0201371. [PMID: 30071042 PMCID: PMC6072022 DOI: 10.1371/journal.pone.0201371] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 07/13/2018] [Indexed: 11/18/2022] Open
Abstract
Background For many years, long-acting intramuscular (LAI) antipsychotics have been prescribed predominantly to chronic and severe patients, as a last resort when other treatments failed. Recently, a broader and earlier use of LAIs, particularly second-generation LAIs, has been emphasized. To date, few studies attempted to frame how this change in prescribing took place in real-world practice. Therefore, this study aimed to describe the clinical features of patients prescribed with LAIs, and to explore possible prescribing differences between first- and second-generations LAIs under ordinary clinical practice in Italy. Methods The STAR Network “Depot” Study is an observational, longitudinal, multicenter study involving 35 centers in Italy. In the cross-sectional phase, patients prescribed with LAIs were consecutively recruited and assessed over a period of 12 months. Descriptive statistics and multivariable logistic regression analyses were employed. Results Of the 451 recruited patients, 61% were males. The level of social and working functioning was heterogeneous, as was the severity of disease. Seventy-two per cent of the patients had a diagnosis of the schizophrenia spectrum. Seventy per cent were prescribed with second-generation antipsychotic (SGA) LAIs (mostly paliperidone, aripiprazole and risperidone). Compared to first-generation antipsychotic (FGA) LAIs, patients prescribed with SGA LAIs were more often younger; employed; with a diagnosis of the schizophrenia spectrum or bipolar disorder; with higher levels of affective symptoms; with fewer LAI prescriptions in the past. Discussion LAIs’ prescribing practices appear to be more flexible as compared to the past, although this change is mostly restricted to SGA LAIs.
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Affiliation(s)
- Giovanni Ostuzzi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- * E-mail:
| | - Maria Angela Mazzi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Samira Terlizzi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Federico Bertolini
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, IRCCS "Policlinico San Martino" Hospital, University of Genoa, Genoa, Italy
- "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
| | - Francesco Bartoli
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Paola Bortolaso
- Università degli Studi dell'Insubria, Dipartimento di Salute Mentale e Dipendenze-ASST Settelaghi Varese, Varese, Italy
| | - Camilla Callegari
- Università degli Studi dell'Insubria, Dipartimento di Salute Mentale e Dipendenze-ASST Settelaghi Varese, Varese, Italy
| | - Mariarita Caroleo
- Department of Health Sciences, Psychiatric Unit, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
- Division of Psychiatry, University College of London, London, UK
| | - Mariangela Corbo
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy
| | - Armando D’Agostino
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
- Department of Mental Health, San Paolo Hospital, Milan, Italy
| | - Chiara Gastaldon
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Claudio Lucii
- Mental Health Department, USL Toscana sudest-Siena, Siena, Italy
| | - Fabio Magliocco
- Department of Health Sciences, Psychiatric Unit, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy
| | - Michela Nosé
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Edoardo Giuseppe Ostinelli
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
- Department of Mental Health, San Paolo Hospital, Milan, Italy
| | - Davide Papola
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Marco Piero Piccinelli
- Università degli Studi dell'Insubria, Dipartimento di Salute Mentale e Dipendenze-ASST Settelaghi Varese, Varese, Italy
| | - Alberto Piccoli
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Tommaso Tabacchi
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Giulia Turrini
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Mirella Ruggeri
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
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Zhang W, Amos TB, Gutkin SW, Lodowski N, Giegerich E, Joshi K. A systematic literature review of the clinical and health economic burden of schizophrenia in privately insured patients in the United States. CLINICOECONOMICS AND OUTCOMES RESEARCH 2018; 10:309-320. [PMID: 29922078 PMCID: PMC5997131 DOI: 10.2147/ceor.s156308] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Purpose The aim of this study was to conduct a systematic literature review on the burden of schizophrenia in privately insured US patients. Materials and methods A systematic literature review of English language peer-reviewed journal articles of observational studies published from 2006 to 2016 was conducted using EMBASE/MEDLINE databases. Abstracts covering substantial numbers of patients with schizophrenia or schizoaffective disorder (i.e., N ≥ 100) were included for full-text review. Articles that did not clearly specify private insurance types were excluded. Results A total of 25 studies were reviewed; 10 included only privately insured patients; and 15 included a mix of different types of insurance. The review of the clinical burden of schizophrenia revealed the following: compared to patients with no mental disorders, those with schizophrenia had significantly increased odds of systemic disorders and both alcohol and substance abuse. Antipsychotic (AP) adherence was low, ranging from 31.5% to 68.7%. The medication possession ratio for AP adherence ranged from 0.22 to 0.73. The review of the health economic burden of schizophrenia revealed the following: patients with a recent (vs. chronic) diagnosis of schizophrenia had significantly higher frequencies of emergency department visits and hospitalizations and greater length of stay (LOS) and total annual per-capita costs. Mean all-cause hospitalizations and LOS decreased significantly after (vs. before) initiating long-acting injectable APs (LAIs). Patients also had significantly decreased mean all-cause, and schizophrenia-related, hospitalization costs after initiating LAIs. Total direct per-capita costs of care (but not pharmacy costs) for patients who were nonadherent to their oral APs within the first 90 days of their index event were significantly higher (vs. early adherent patients). Despite these potential benefits, only 0.25%–13.1% of patients were treated with LAIs across all studies. Conclusion Privately insured US patients with schizophrenia experience a substantial clinical and health economic burden related to comorbidities, acute care needs, nonadherence, and polypharmacy and have relatively low use of LAIs. Further study is warranted to understand prescribing patterns and clinical policies related to this patient population.
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Affiliation(s)
- Wenjie Zhang
- WG US Advanced Health Analytics (WG AHA), Stamford, CT, USA
| | - Tony B Amos
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | | | | | - Emma Giegerich
- WG US Advanced Health Analytics (WG AHA), Stamford, CT, USA
| | - Kruti Joshi
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
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25
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Girardi P, Del Casale A, Rapinesi C, Kotzalidis GD, Splendori F, Verzura C, Trovini G, Sorice S, Carrus D, Mancinelli I, Comparelli A, De Filippis S, Francomano A, Ballerini A, Marcellusi A, Mennini FS, Ducci G, Sani G, Pompili M, Brugnoli R. Predictive factors of overall functioning improvement in patients with chronic schizophrenia and schizoaffective disorder treated with paliperidone palmitate and aripiprazole monohydrate. Hum Psychopharmacol 2018; 33:e2658. [PMID: 29766576 DOI: 10.1002/hup.2658] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/22/2018] [Accepted: 04/09/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Long-acting injectable (LAI) antipsychotics can improve medication adherence and reduce hospitalisation rates compared with oral treatments. Paliperidone palmitate (PAL) and aripiprazole monohydrate (ARI) LAI treatments were associated with improvements in global functioning in patients with schizophrenia. OBJECTIVE The objective of this study was to assess the predictive factors of better overall functioning in patients with chronic schizophrenia and schizoaffective disorder treated with PAL and ARI. METHOD Enrolled were 143 (97 males, 46 females, mean age 38.24 years, SD = 12.65) patients with a diagnosis of schizophrenia or schizoaffective disorder, whom we allocated in two groups (PAL and ARI treatments). We assessed global functioning, amount of oral medications, adherence to oral treatment, and number of hospitalisations before LAI introduction and at assessment time point. RESULTS Longer treatment time with LAIs (p < .001), lower number of oral drugs (p < .001), and hospitalisations (p = .002) before LAI introduction, and shorter duration of illness (p = .038) predicted better Global Assessment of Functioning scores in the whole sample (R2 = 0.337). CONCLUSION Early administration and longer duration of ARI or PAL treatments could play a significant role in improving global functioning of patients with schizophrenia and schizoaffective disorder. Better improvement in functioning could be achieved with ARI in young individuals with recent illness onset and PAL in patients at risk for recurrent hospitalisations.
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Affiliation(s)
- Paolo Girardi
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Sapienza University, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | - Antonio Del Casale
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Sapienza University, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | - Chiara Rapinesi
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Sapienza University, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | - Georgios D Kotzalidis
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Sapienza University, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | - Francesca Splendori
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Sapienza University, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | - Claudio Verzura
- Residency School in Psychiatry, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Giada Trovini
- Residency School in Psychiatry, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Serena Sorice
- Residency School in Psychiatry, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Dario Carrus
- Mental Health Department, Azienda Sanitaria Locale Viterbo, Viterbo, Italy
| | - Iginia Mancinelli
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Sapienza University, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | - Anna Comparelli
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Sapienza University, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | | | - Antonio Francomano
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Palermo, Italy
| | - Andrea Ballerini
- Department of Neuroscience, Psychology, Drug Research and Child Health, Section of Neuroscience, University of Florence, Florence, Italy
| | - Andrea Marcellusi
- Faculty of Economics, Centre for Economic and International Studies (CEIS)-Economic Evaluation and HTA (EEHTA), Tor Vergata University, Rome, Italy
| | - Francesco S Mennini
- Faculty of Economics, Centre for Economic and International Studies (CEIS)-Economic Evaluation and HTA (EEHTA), Tor Vergata University, Rome, Italy
| | - Giuseppe Ducci
- Mental Health Department, Azienda Sanitaria Locale Roma 1, Rome, Italy
| | - Gabriele Sani
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Sapienza University, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | - Maurizio Pompili
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Sapienza University, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | - Roberto Brugnoli
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Sapienza University, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
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Effects of oral versus long-acting antipsychotics on social functioning: A psychiatrists' survey in India. Asian J Psychiatr 2017; 30:88-93. [PMID: 28843143 DOI: 10.1016/j.ajp.2017.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 08/04/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Schizophrenia is associated with functional challenges for patients; relapses in schizophrenia may lead to increased treatment costs and poor quality of life. OBJECTIVE This SUSTAIN-I study was conducted to establish psychiatrists' perspective on impact of long-acting injectables (LAIs) antipsychotics on the socio-economic and functional burden of schizophrenia. METHODS This cross-sectional, survey-based study was conducted in 5 cities in India. Psychiatrists (≥5years of experience) working in clinics, psychiatric, government hospitals and rehabilitation centers were included and administered a specially designed questionnaire to elicit information on their clinical practice and prescription patterns. Perceived treatment costs for LAI versus oral antipsychotic treatments (OATs) and relapse rates were assessed. Descriptive statistics were used to summarize results. RESULTS Total 31 physicians completed this survey. In acute phase, OAT prescription was higher whereas chronic patients were treated with either OATs or LAIs. Treatment with LAIs was the preferred treatment in 9% of chronic cases. Reduced relapse rates were observed with LAI treatment: 12% patients on LAIs relapsed as compared with 60% patients on OATs. Monthly medication cost for oral medications was lower ($8-$17) than short-acting injectables ($22-$50). For chronic cases, atypical antipsychotics cost (oral: $11.7-25, LAI: $150-167) was higher than typical antipsychotics (oral: $4-5, LAI: $5-25). Of the total expenses incurred, cost for hospital admissions was the largest component (78%). CONCLUSION Despite enhanced treatment adherence and potential to lower risk of rehospitalizations from relapse, LAIs are not the preferred treatment choice for patients with schizophrenia in India, owing to their perceived high costs.
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27
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Citrome L. Long-acting injectable antipsychotics update: lengthening the dosing interval and expanding the diagnostic indications. Expert Rev Neurother 2017; 17:1029-1043. [DOI: 10.1080/14737175.2017.1371014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Leslie Citrome
- Department of Psychiatry & Behavioral Sciences, New York Medical College, Valhalla, NY, USA
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28
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Shafrin J, Schwartz TT, Lakdawalla DN, Forma FM. Estimating the Value of New Technologies That Provide More Accurate Drug Adherence Information to Providers for Their Patients with Schizophrenia. J Manag Care Spec Pharm 2017; 22:1285-1291. [PMID: 27783545 PMCID: PMC10397938 DOI: 10.18553/jmcp.2016.22.11.1285] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Nonadherence to antipsychotic medication among patients with schizophrenia results in poor symptom management and increased health care and other costs. Despite its health impact, medication adherence remains difficult to accurately assess. New technologies offer the possibility of real-time patient monitoring data on adherence, which may in turn improve clinical decision making. However, the economic benefit of accurate patient drug adherence information (PDAI) has yet to be evaluated. OBJECTIVE To quantify how more accurate PDAI can generate value to payers by improving health care provider decision making in the treatment of patients with schizophrenia. METHODS A 3-step decision tree modeling framework was used to measure the effect of PDAI on annual costs (2016 U.S. dollars) for patients with schizophrenia who initiated therapy with an atypical antipsychotic. The first step classified patients using 3 attributes: adherence to antipsychotic medication, medication tolerance, and response to therapy conditional on medication adherence. The prevalence of each characteristic was determined from claims database analysis and literature reviews. The second step modeled the effect of PDAI on provider treatment decisions based on health care providers' survey responses to schizophrenia case vignettes. In the survey, providers were randomized to vignettes with access to PDAI and with no access. In the third step, the economic implications of alternative provider decisions were identified from published peer-reviewed studies. The simulation model calculated the total economic value of PDAI as the difference between expected annual patient total cost corresponding to provider decisions made with or without PDAI. RESULTS In claims data, 75.3% of patients with schizophrenia were found to be nonadherent to their antipsychotic medications. Review of the literature revealed that 7% of patients cannot tolerate medication, and 72.9% would respond to antipsychotic medication if adherent. Survey responses by providers (n = 219) showed that access to PDAI would significantly alter treatment decisions for nonadherent or adherent/poorly controlled patients (P < 0.001). Payers can expect to save $3,560 annually per nonadherent patient who would respond to therapy if adherent. Savings increased to $9,107 per nonadherent patient when PDAI was given to providers who frequently augmented therapy for these patients. Among all poorly controlled patients (i.e., the nonadherent or those who were adherent but unresponsive to therapy), access to PDAI decreased annual patient cost by $2,232. Savings for this group increased to $7,124 per patient when PDAI was given to providers who frequently augmented therapy. CONCLUSIONS Access to PDAI significantly improved provider decision making, leading to lower annual health care costs for patients who were nonadherent or adherent but poorly controlled. Additional research is warranted to evaluate how new technologies that accurately monitor adherence would affect health and economic outcomes among patients with serious mental illness. DISCLOSURES This study and medical writing assistance was funded by Otsuka Pharmaceutical Development & Commercialization. Shafrin and Schwartz are employees of Precision Health Economics, which received funding from Otsuka Pharmaceutical Development & Commercialization in support of this study. Lakdawalla is Chief Scientific Officer and a founding partner of Precision Health Economics. Schwartz is a consultant for Otsuka Pharmaceutical Development & Commercialization, and Forma is an employee of Otsuka Pharmaceutical Development & Commercialization. The authors presented the abstract for this study as a poster presentation at the AMCP Managed Care & Specialty Pharmacy Annual Meeting, April 19-22, 2016, San Francisco, California. All authors contributed equally to the study design, data collection and analysis, and the writing and revision of the manuscript.
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Affiliation(s)
- Jason Shafrin
- 1 Precision Health Economics, Los Angeles, California
| | | | - Darius N Lakdawalla
- 2 Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles
| | - Felicia M Forma
- 3 Otsuka Pharmaceutical Development & Commercialization, Princeton, New Jersey
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29
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Mesones-Peral JE, Gurillo-Muñoz P, Sánchez-Sicilia MP, Miller A, Griñant-Fernández A. Hospitalizaciones y análisis económico en pacientes psicóticos con palmitato de paliperidona de larga duración. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2017; 10:33-37. [DOI: 10.1016/j.rpsm.2016.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 12/29/2015] [Accepted: 01/20/2016] [Indexed: 10/22/2022]
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30
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Rezansoff SN, Moniruzzaman A, Fazel S, Procyshyn R, Somers JM. Adherence to antipsychotic medication among homeless adults in Vancouver, Canada: a 15-year retrospective cohort study. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1623-1632. [PMID: 27338740 PMCID: PMC5091737 DOI: 10.1007/s00127-016-1259-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/15/2016] [Indexed: 12/22/2022]
Abstract
PURPOSE The purpose of this study was to investigate the level of adherence to antipsychotic prescription medication in a well-defined homeless cohort over a 15-year period. We hypothesized that adherence would be well below the recommended threshold for clinical effectiveness (80 %), and that it would be strongly associated with modifiable risk factors in the social environment in which homeless people live. METHOD Linked baseline data (including comprehensive population-level administrative prescription records) were examined in a subpopulation of participants from two pragmatic-randomized trials that investigated Housing First for homeless and mentally ill adults. Adherence to antipsychotic medication was operationalized using the medication possession ratio. Multivariable logistic regression was used to estimate effect sizes between socio-demographic, homelessness-related and illness factors, and medication possession ratio. RESULTS Among the 290 participants who met inclusion criteria for the current analysis, adherence to antipsychotic prescription was significantly associated with: history of psychiatric hospitalization; receipt of primary medical services; long-acting injectable antipsychotic formulations; and duration of homelessness. Mean medication possession ratio in the pre-randomization period was 0.41. Socio-demographic characteristics previously correlated with antipsychotic non-adherence were not significantly related to medication possession ratio. CONCLUSIONS This is the first study to quantify the very low level of adherence to antipsychotic medication among homeless people over an extended observation period of 15 years. Each of the four factors found to be significantly associated with adherence presents opportunities for intervention. Strategies to end homelessness for this population may represent the greatest opportunity to improve adherence to antipsychotic medication.
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Affiliation(s)
- Stefanie N Rezansoff
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
| | - A Moniruzzaman
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - S Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, 0X3 7JX, UK
| | - R Procyshyn
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada
| | - J M Somers
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
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31
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Stevens GL, Dawson G, Zummo J. Clinical benefits and impact of early use of long-acting injectable antipsychotics for schizophrenia. Early Interv Psychiatry 2016; 10:365-77. [PMID: 26403538 PMCID: PMC5054869 DOI: 10.1111/eip.12278] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 08/17/2015] [Indexed: 01/31/2023]
Abstract
AIM Results from clinical trials support the use of oral antipsychotics for treatment of early or first-episode psychosis in patients with schizophrenia. This paper will review literature on the advantages of early initiation of treatment for schizophrenia and the clinical benefits of early use of long-acting injectable antipsychotics (LAIs). METHOD A comprehensive literature review was conducted to identify published literature on the use of LAIs early in the treatment of schizophrenia. RESULTS Although there is a higher response rate to initial antipsychotic treatment for a first-episode of schizophrenia than with subsequent antipsychotic treatment, we have not effectively addressed this issue. Poor adherence to treatment is a primary cause of relapse and rehospitalization in subsequent years and was associated with higher relapse rates resulting in devastating effects and substantial economic burden. The costs of nonadherence were estimated to be $1.48 billion. Thus, a major challenge with the treatment of schizophrenia is changing poor adherence to persistence with antipsychotic therapy. LAIs are known to be at least as effective as oral antipsychotics for treating schizophrenia, and yet are underutilized. Further, LAIs address many of the problems associated with adherence to oral therapy. Recent evidence suggests that LAIs are effective for treating first-episode psychosis and for early initiation of treatment for schizophrenia. CONCLUSION Although consistent antipsychotic treatment represents a critical part of treatment, a person-centred approach to treating schizophrenia is essential for all aspects of care, including establishing and maintaining a therapeutic alliance, strengthening shared decision-making and adherence, and achieving long-lasting recovery.
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Affiliation(s)
- Georgia L Stevens
- Partners in Aging & Long-Term Caregiving, Washington, District of Columbia, USA.
| | - Gail Dawson
- Wholeness Center, Fort Collins, Colorado, USA
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Hargarter L, Bergmans P, Cherubin P, Keim S, Conca A, Serrano-Blanco A, Bitter I, Bilanakis N, Schreiner A. Once-monthly paliperidone palmitate in recently diagnosed and chronic non-acute patients with schizophrenia. Expert Opin Pharmacother 2016; 17:1043-53. [PMID: 27042990 PMCID: PMC4898156 DOI: 10.1080/14656566.2016.1174692] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objective: To explore the treatment response, tolerability and safety of once-monthly paliperidone palmitate (PP1M) in non-acute patients switched from oral antipsychotics, stratified by time since diagnosis as recently diagnosed (≤3 years) or chronic patients (>3 years). Research design and methods: Post hoc analysis of a prospective, interventional, single-arm, multicentre, open-label, 6-month study performed in 233 recently diagnosed and 360 chronic patients. Main outcome measures: The proportion achieving treatment response (defined as ≥20% improvement in Positive and Negative Syndrome Scale [PANSS] total score from baseline to endpoint) and maintained efficacy (defined as non-inferiority in the change in PANSS total score at endpoint [Schuirmann’s test]). Results: 71.4% of recently diagnosed and 59.2% of chronic patients showed a ≥20% decrease in PANSS total score (p = 0.0028 between groups). Changes in PANSS Marder factors, PANSS subscales, and the proportion of patients with a Personal and Social Performance scale (PSP) total score of 71–100 were significantly greater in recently diagnosed compared with chronic patients. PP1M was well tolerated, presenting no unexpected safety findings. Conclusion: These data show that recently diagnosed patients treated with PP1M had a significantly higher treatment response and improved functioning, as assessed by the PSP total score, than chronic patients.
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Affiliation(s)
- L Hargarter
- a Medical & Scientific Affairs , Janssen Cilag EMEA , Neuss , Germany
| | - P Bergmans
- b Biometrics & Reporting , Janssen Cilag Benelux , Tilburg , The Netherlands
| | - P Cherubin
- c Medical Affairs , Janssen Cilag EMEA , Issy-les-Moulineaux , France
| | - S Keim
- d Global Clinical Operations EMEA MAO, Janssen Cilag , Barcarena , Portugal
| | - A Conca
- e Department of Psychiatry , General Hospital , Bolzano , Italy
| | - A Serrano-Blanco
- f Acute Inpatient Unit , Parc Sanitari Sant Joan de Déu , Barcelona , Spain and redIAPP, Spain
| | - I Bitter
- g Department of Psychiatry and Psychotherapy , Semmelweis University , Budapest , Hungary
| | - N Bilanakis
- h Department of Psychiatric , General Hospital of Arta , Arta , Greece
| | - A Schreiner
- a Medical & Scientific Affairs , Janssen Cilag EMEA , Neuss , Germany
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Williams W, McKinney C, Martinez L, Benson C. Recovery outcomes of schizophrenia patients treated with paliperidone palmitate in a community setting: patient and provider perspectives on recovery. J Med Econ 2016; 19:469-76. [PMID: 26671481 DOI: 10.3111/13696998.2015.1131989] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES This study evaluated the effect of paliperidone palmitate long-acting injectable (LAI) antipsychotic on recovery-oriented mental health outcomes from the perspective of healthcare providers and patients during the treatment of patients with schizophrenia or schizoaffective disorders. METHODS Archival data for patients with a primary diagnosis of schizophrenia or schizoaffective disorder receiving ≥6 months of paliperidone palmitate LAI were retrieved from the electronic medical records system at the Mental Health Center of Denver. Mental health recovery was assessed from both a provider's (Recovery Markers Inventory [RMI]) and patient's (Consumer Recovery Measure [CRM]) perspective. A three-level hierarchical linear model (HLM) was utilized to determine changes in CRM and RMI scores by including independent variables in the models: intercept, months from treatment (slope), treatment time period (pretreatment and treatment), age, gender, primary diagnosis, substance abuse diagnosis, concurrent medications, and adherence to paliperidone palmitate LAI. RESULTS A total of 219 patients were identified and included in the study. Results of the final three-level HLMs indicated an overall increase in CRM scores (p < 0.05), an overall increase (p < 0.01), and an increased rate of change (p < 0.05) in RMI scores during the paliperidone palmitate LAI treatment period vs the pre-treatment period. LIMITATIONS This study contained a retrospective, non-comparative design, and did not adjust for multiplicity Conclusions: The current study demonstrates that changes in recovery-oriented mental health outcomes can be detected following the administration of a specific antipsychotic treatment in persons with schizophrenia or schizoaffective disorders. Furthermore, patients receiving paliperidone palmitate LAI can effectively improve recovery-oriented outcomes, thereby supporting the drug's use as schizophrenia treatment from a recovery-oriented perspective.
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Affiliation(s)
| | | | - Larry Martinez
- b b Janssen Scientific Affairs , LLC , Titusville , NJ , USA
| | - Carmela Benson
- b b Janssen Scientific Affairs , LLC , Titusville , NJ , USA
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Kane JM, Zhao C, Johnson BR, Baker RA, Eramo A, McQuade RD, Duca AR, Sanchez R, Peters-Strickland T. Hospitalization rates in patients switched from oral anti-psychotics to aripiprazole once-monthly: final efficacy analysis. J Med Econ 2015; 18:145-54. [PMID: 25347448 PMCID: PMC4743596 DOI: 10.3111/13696998.2014.979936] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare hospitalization rates in patients with schizophrenia treated prospectively with aripiprazole once-monthly 400 mg (AOM 400; an extended-release injectable suspension) vs the same patients' retrospective rates with their prior oral anti-psychotic therapy. RESEARCH DESIGN AND METHODS Multi-center, open-label, mirror-image, naturalistic study in a community setting in North America. Patients who required a change in treatment and/or would benefit from long-acting injectable anti-psychotic therapy were treated prospectively for 6 months with AOM 400. Retrospective data on hospitalization rates were obtained. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov: NCT01432444. MAIN OUTCOME MEASURES The proportion of patients with ≥ 1 psychiatric inpatient hospitalization with oral anti-psychotic therapy examined retrospectively (months -4 to -1 before oral conversion) and after switching to AOM 400 (months 4-6 after initiating AOM 400). RESULTS Psychiatric hospitalization rates were significantly lower when patients were treated with AOM 400 compared with oral anti-psychotic therapy both in the 3-month primary efficacy sample (2.7% [n = 9/336] vs 27.1% [n = 91/336], respectively; p < 0.0001) and in the total sample (6-month prospective rate: 8.8% [n = 38/433] vs 6-month retrospective rate: 38.1% [n = 165/433]; p < 0.0001). Discontinuations due to adverse events (AEs) during cross-titration were lower in patients cross-titrated on oral aripiprazole for >1 and <4 weeks (2.9% [n = 7/239]) compared with patients cross-titrated for ≤ 1 week (10.4% [n = 5/48]). The most common treatment-emergent AEs during the prospective treatment phase were insomnia (6.7% [n = 29/431]) and akathisia (6.5% [n = 28/431]). Patient-rated injection-site pain decreased from the first injection to the last visit. CONCLUSIONS In a community setting, patients with schizophrenia demonstrated significantly lower psychiatric hospitalization rates after switching from their prior oral anti-psychotic therapy to AOM 400. Patients served as their own control, and thus an active control group was not included in this study. Confounding factors, such as insurance coverage and availability of hospital beds, were not examined here and deserve further consideration.
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Affiliation(s)
- John M. Kane
- The Zucker Hillside Hospital, Glen Oaks, and the Hofstra North Shore-LIJ School of Medicine,
Hempstead,
NY,
USA
- Address for correspondence: John M. Kane, MD,
The Zucker Hillside Hospital, 75-59 263rd Street, Kaufmann Building, Suite 103,
Glen Oaks,
NY 11004-1100,
USA. Tel: 718-470-8141; Fax: 718-343-7739;
| | - Cathy Zhao
- Biostatistics, Otsuka Pharmaceutical Development & Commercialization, Inc.,
Princeton,
NJ,
USA
| | - Brian R. Johnson
- Clinical Management, Otsuka Pharmaceutical Development & Commercialization, Inc.,
Princeton,
NJ,
USA
| | - Ross A. Baker
- CNS Global Medical Affairs, Otsuka Pharmaceutical Development & Commercialization, Inc.,
Princeton,
NJ,
USA
| | - Anna Eramo
- Medical Affairs & Phase IV Clinical Affairs, Lundbeck LLC,
Deerfield,
IL,
USA
| | - Robert D. McQuade
- Global Medical, Regulatory Affairs and Alliances, Otsuka Pharmaceutical Development & Commercialization, Inc.,
Princeton,
NJ,
USA
| | - Anna R. Duca
- Clinical Management, Otsuka Pharmaceutical Development & Commercialization, Inc.,
Princeton,
NJ,
USA
| | - Raymond Sanchez
- Global Clinical Development (CNS), Otsuka Pharmaceutical Development & Commercialization, Inc.,
Princeton,
NJ,
USA
| | - Timothy Peters-Strickland
- Global Clinical Development (CNS), Otsuka Pharmaceutical Development & Commercialization, Inc.,
Princeton,
NJ,
USA
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Simić-Medojević I, Burgić-Radmanović M. Quality of life of schizophrenic patients with or without depot neuroleptics. SCRIPTA MEDICA 2015. [DOI: 10.5937/scrimed1501060s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Alphs L, Bossie CA, Fu DJ, Ma YW, Kern Sliwa J. Onset and persistence of efficacy by symptom domain with long-acting injectable paliperidone palmitate in patients with schizophrenia. Expert Opin Pharmacother 2014; 15:1029-42. [PMID: 24754314 DOI: 10.1517/14656566.2014.909409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Several long-acting injectable (LAI) second-generation antipsychotics are now available for the management of schizophrenia. As patients with schizophrenia frequently present with diverse and challenging symptoms, it is important to understand the effects of antipsychotics in treating these different symptom subgroups and the timing of these responses. AREAS COVERED For this review, data from two randomized, double-blind trials were analyzed in respect to the onset and persistence of effects on several measures of psychopathology (as measured by the Positive and Negative Syndrome Scale [PANSS]) after treatment with LAI paliperidone palmitate (PP) (NCT00590577 and NCT00589914). EXPERT OPINION Symptom reductions from baseline with PP were significant by day 4 for all five PANSS factors in both studies. Some effects may have been driven by the presence or absence of a placebo response. A significant effect for PP versus placebo was observed for all major symptom domains for one or more doses of PP during the first month of treatment. Once established, most (but not all) significant responses persisted to the end point. Similar improvements were observed in PANSS scores with PP and oral risperidone. Dose-dependent trends were observed for the effect of PP on positive, negative and uncontrolled hostility/excitement symptoms.
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Affiliation(s)
- Larry Alphs
- Therapeutic Area Leader Psychiatry, Janssen Scientific Affairs, LLC , 1125 Trenton-Harbourton Road-A32404, Titusville, NJ 08560 , USA +1 609 730 3693 ; +1 609 730 3125 ;
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Brissos S, Veguilla MR, Taylor D, Balanzá-Martinez V. The role of long-acting injectable antipsychotics in schizophrenia: a critical appraisal. Ther Adv Psychopharmacol 2014; 4:198-219. [PMID: 25360245 PMCID: PMC4212490 DOI: 10.1177/2045125314540297] [Citation(s) in RCA: 208] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Despite their widespread use, long-acting injectable (LAI) antipsychotics (APs) are often regarded with some negativity because of the assumption of punishment, control and insufficient evolution towards psychosocial development of patients. However, LAI APs have proved effective in schizophrenia and other severe psychotic disorders because they assure stable blood levels, leading to a reduction of the risk of relapse. Therapeutic opportunities have also arisen after introduction of newer, second-generation LAI APs in recent years. Newer LAI APs are more readily dosed optimally, may be better tolerated and are better suited to integrated rehabilitation programmes. This review outlines the older and newer LAI APs available for the treatment of schizophrenia, with considerations of past and present pharmacological and therapeutic issues. Traditional, evidence-based approaches to systematic reviews and randomized clinical trials are of limited utility in this area so this paper's blending of experimental trials with observational research is particularly appropriate and effective.
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Affiliation(s)
- Sofia Brissos
- Psychiatrist, Lisbon's Psychiatric Hospitalar Centre, Rua Conde de Redondo, nº 8 3º dt., Lisbon, 1150, Portugal
| | - Miguel Ruiz Veguilla
- Grupo Psicosis y Neurodesarrollo, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocio /CSIC/Universidad de Sevilla, Unidad de Hospitalizacion de Salud Mental, Sevilla, Spain
| | - David Taylor
- South London and Maudsley NHS Foundation Trust, Pharmacy Department, Maudsley Hospital, Denmark Hill, London, UK
| | - Vicent Balanzá-Martinez
- Catarroja Mental Health Unit, University Hospital Doctor Peset, FISABIO, Valencia; and Section of Psychiatry, University of Valencia, CIBERSAM, Valencia, Spain
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Magura S, Mateu PF, Rosenblum A, Matusow H, Fong C. Risk factors for medication non-adherence among psychiatric patients with substance misuse histories. ACTA ACUST UNITED AC 2013; 7:381-390. [PMID: 25309623 DOI: 10.1080/17523281.2013.839574] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Medication non-adherence among psychiatric patients is known to be associated with poorer treatment outcomes. The study examined a comprehensive set of modifiable risk factors for non-adherence in a theoretical framework among a diverse, high risk sample of psychiatric patients with substance misuse histories (N=299). Medication side effects and excessive alcohol use were related to lower medication adherence and higher motivation for mental health treatment and recovery support were related to greater adherence. The results suggest that a multifaceted model for intervention to increase psychiatric medication adherence should be developed and tested.
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Affiliation(s)
- Stephen Magura
- The Evaluation Center, Western Michigan University, Kalamazoo MI 49008 USA
| | - Pedro F Mateu
- The Evaluation Center, Western Michigan University, Kalamazoo MI 49008 USA
| | - Andrew Rosenblum
- National Development and Research Institutes, New York, New York, 10010
| | - Harlan Matusow
- National Development and Research Institutes, New York, New York, 10010
| | - Chunki Fong
- National Development and Research Institutes, New York, New York, 10010
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Kane JM, Sanchez R, Zhao J, Duca AR, Johnson BR, McQuade RD, Eramo A, Baker RA, Peters-Strickland T. Hospitalisation rates in patients switched from oral anti-psychotics to aripiprazole once-monthly for the management of schizophrenia. J Med Econ 2013; 16:917-25. [PMID: 23663091 PMCID: PMC3709884 DOI: 10.3111/13696998.2013.804411] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To report the design and preliminary results of a mirror-image study comparing total psychiatric hospitalisation rates pre- and post-switch to aripiprazole once-monthly, an extended release injectable solution. METHODS A multi-center, open-label mirror-image study of patients (18-65 years) with schizophrenia to compare total psychiatric hospitalisation rates between retrospective treatment with oral standard-of-care (SOC) anti-psychotics and prospective treatment with aripiprazole once-monthly in a naturalistic community setting in North America. Total psychiatric hospitalisation rates were assessed between retrospective (Months -4 to -1) and prospective treatment periods (Months 4-6) for patients who completed ≥3 months aripiprazole once-monthly. RESULTS One hundred and eighty-three patients entered the prospective phase. After switching to aripiprazole once-monthly, total psychiatric hospitalisation rates for the 3-month prospective period were significantly lower (p < 0.0001, Exact McNemar's test) compared with the retrospective 3-month period when the same patients received SOC anti-psychotics (6.6% [n = 8/121] vs 28.1% [n = 34/121], respectively; rate ratio = 0.24). Similarly, total psychiatric hospitalisation rates for all patients who entered the prospective treatment phase were significantly lower (p < 0.0001, Exact McNemar's test) for the prospective 6 months following switch to aripiprazole once-monthly, compared with the retrospective 6-month SOC period (14.2% [n = 26/183] vs 41.5% [n = 76/183], respectively; rate ratio = 0.34). Common treatment-emergent adverse events (occurring in ≥5% of patients) were psychotic disorder (7.7%), akathisia (7.2%), and insomnia (7.2%). Discontinuation (all causes) during the prospective phase was 44.8% (n = 82/183). LIMITATIONS Mirror-image studies do not include a parallel active control; as each patient serves as their own control, it cannot be determined whether other treatments may have similar effects. Treatment and trial effects may be difficult to separate. Independent factors such as admission patterns, insurance coverage, availability of hospital beds, and community support may influence rates of hospitalisation. CONCLUSIONS Switching to aripiprazole once-monthly substantially reduced total psychiatric hospitalisation rates compared with retrospective rates in the same patients taking oral SOC.
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Affiliation(s)
- John M. Kane
- Department of Psychiatry, The Zucker Hillside Hospital and the Hofstra North Shore-LIJ School of MedicineGlen Oaks, NYUSA
| | - Raymond Sanchez
- Global Clinical Development (CNS), Otsuka Pharmaceutical Development & Commercialization, Inc.Princeton, NJUSA
| | - Joan Zhao
- Biostatistics, Otsuka Pharmaceutical Development & Commercialization, Inc.Princeton, NJUSA
| | - Anna R. Duca
- Clinical Management, Otsuka Pharmaceutical Development & Commercialization, Inc.Princeton, NJUSA
| | - Brian R. Johnson
- Clinical Management, Otsuka Pharmaceutical Development & Commercialization, Inc.Princeton, NJUSA
| | - Robert D. McQuade
- Global Medical, Regulatory Affairs and Alliances, Otsuka Pharmaceutical Development & Commercialization, Inc.Princeton, NJUSA
| | - Anna Eramo
- Medical Affairs & Phase IV Clinical AffairsH. Lundbeck A/S, Deerfield, ILUSA
| | - Ross A. Baker
- CNS Global Medical Affairs, Otsuka Pharmaceutical Development & Commercialization, Inc.Princeton, NJUSA
| | - Timothy Peters-Strickland
- Global Clinical Development (CNS), Otsuka Pharmaceutical Development & Commercialization, Inc.Princeton, NJUSA
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Kaplan G, Casoy J, Zummo J. Impact of long-acting injectable antipsychotics on medication adherence and clinical, functional, and economic outcomes of schizophrenia. Patient Prefer Adherence 2013; 7:1171-80. [PMID: 24265549 PMCID: PMC3833623 DOI: 10.2147/ppa.s53795] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
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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Affiliation(s)
- Gabriel Kaplan
- Behavioral Health Services, Bergen Regional Medical Center, Paramus, NJ, USA
- Department of Psychiatry, Rutgers New Jersey Medical School, Newark, NJ, USA
- Correspondence: Gabriel Kaplan, 535 Morris Avenue, Springfield, NJ 07081, USA, Tel +1 973 376 1020, Email
| | - Julio Casoy
- Medical Affairs, Alkermes, Inc., Waltham, MA, USA
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