High doses of second-generation long-acting antipsychotics in the treatment of patients with severe resistant schizophrenia. A six-year mirror-image study.

AimsTo evaluate the effect of the use of aripiprazole and paliperidone long acting injections on healthcare resource useBackgroundLong acting injections of second-generation antipsychotics such as paliperidone and aripiprazole have become more commonly prescribed over the past decade. They have much higher acquisition costs when compared to first generation depot antipsychotics. It is therefore essential to demonstrate their tolerability and cost-effectiveness.MethodWe undertook an observational, retrospective two-year mirror study for all patients who started treatment with paliperidone long acting injection between January and June 2016 (n = 47) or aripiprazole long acting injection between April 2014 and July 2017 (n = 93). Clinical notes were examined to determine the number of admissions, inpatient days, home treatment episodes and number of home treatment days, in the 12 months preceding and following the commencement of the long acting injection.Result70% remained on paliperidone and 62% remained on aripiprazole at the end of the one-year period.There was a significant reduction in occupied bed days in those treated with paliperidone from 78.2 days in the year before this treatment was started to 25.4 days in the year after (p = 0.002). There was a significant reduction in occupied bed days in those treated with aripiprazole from 66.51 days to 32.7 days (p = 0.0006).There was no significant reduction in days spent under the care of home treatment teams for individuals treated with either of these medicines.ConclusionTreatment with either paliperidone or aripiprazole long-acting injection was associated with a reduction in admissions and occupied bed days of a magnitude that delivered an overall cost-saving despite the high drug acquisition costs. It remains to be determined how these reductions compare with other second-generation long-acting injections and first-generation depot antipsychotics.

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One-year mirror-image study of the impact of olanzapine long-acting injection on healthcare resource utilization and costs in severe schizophrenia

Psychiatry Research ◽

10.1016/j.psychres.2018.09.041 ◽

2018 ◽

Vol 270 ◽

pp. 205-210 ◽

Cited By ~ 2

Author(s):

Mylène Fefeu ◽

Pierre De Maricourt ◽

Arnaud Cachia ◽

Nicolas Hoertel ◽

Marie-Noëlle Vacheron ◽

...

Keyword(s):

Resource Utilization ◽

Healthcare Resource ◽

Healthcare Resource Utilization ◽

Mirror Image ◽

Image Study ◽

One Year ◽

Long Acting ◽

The Impact

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Haloperidol decanoate long-acting injection (HDLAI): Results of a 1-year mirror-image study

Therapeutic Advances in Psychopharmacology ◽

10.1177/2045125318767587 ◽

2018 ◽

Vol 8 (9) ◽

pp. 241-249 ◽

Cited By ~ 3

Author(s):

Shubhra Mace ◽

Olubanke Dzahini ◽

Maria O’Hagan ◽

David Taylor

Keyword(s):

Relative Risk ◽

Hospital Admissions ◽

Mirror Image ◽

Discontinuation Rate ◽

Haloperidol Decanoate ◽

Image Study ◽

Duration Of Illness ◽

Bed Days ◽

Long Acting ◽

High Treatment

Background: We sought to determine clinical outcomes of the prescribing of haloperidol decanoate long-acting injection (HDLAI) at 1 year. Method: A 1-year mirror-image study of 84 inpatients initiated on HDLAI. Admissions and bed days in the year preceding HDLAI were compared with the year after initiation. Predictors for discontinuation were evaluated. Results: At 1 year, 33% of patients remained on treatment. Patients starting HDLAI because of nonadherence were more likely to stop treatment [relative risk (RR) 1.72; 95% confidence interval (CI) 1.01, 2.91; p = 0.044] whilst patients with a longer duration of illness were more likely to remain on treatment (RR 0.88; 95% CI 0.78, 1.00; p = 0.050). In the bed days cohort overall, ( n = 65), there was a significant reduction in mean hospital admissions (1.4/patient/year to 0.6/patient/year; p = 0.0001) but not bed days (55.6/patient to 45.0/patient; p = 0.07) in the year following HDLAI initiation compared with the year before. Continuers had a significant reduction in mean bed days (53.1 to 4.0; p = 0.0002) and hospital admissions (1.5 to 0.2; p = 0.0001). Discontinuers demonstrated a significant reduction in hospital admissions (1.5 to 0.8; p = 0.0001) but not bed days (56.7 to 64.5; p = 0.83). Conclusion: HDLAI was associated with a high treatment discontinuation rate. Hospital admissions fell in the year after HDLAI but there was no change in bed days. Our study suggests that patients with a longer duration of illness and patients initiated on HDLAI for reasons other than poor adherence may benefit from HDLAI initiation.

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Changes in length of hospital stay before and after the administration of a long-acting injection in patients with schizophrenia: Mirror-image study

Psychiatry and Clinical Neurosciences ◽

10.1111/pcn.12391 ◽

2016 ◽

Vol 70 (6) ◽

pp. 255-255 ◽

Cited By ~ 2

Author(s):

Hidenobu Suzuki ◽

Hiroyuki Hibino ◽

Yuichi Inoue

Keyword(s):

Hospital Stay ◽

Length Of Hospital Stay ◽

Mirror Image ◽

Image Study ◽

Before And After ◽

Long Acting

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Partial compliance with long-acting paliperidone palmitate and impact on hospitalization: a 6-year mirror-image study

Therapeutic Advances in Psychopharmacology ◽

10.1177/2045125320924789 ◽

2020 ◽

Vol 10 ◽

pp. 204512532092478 ◽

Cited By ~ 1

Author(s):

Sofia Pappa ◽

Katy Mason

Keyword(s):

Hospital Admissions ◽

Mirror Image ◽

Poor Compliance ◽

Paliperidone Palmitate ◽

Image Study ◽

Partial Compliance ◽

Before And After ◽

The Mean ◽

Oral Antipsychotic ◽

Long Acting

Background: Previous studies showed a linear correlation between partial compliance with an oral antipsychotic medication and hospitalisation risk among patients with schizophrenia. Long-acting injections (LAIs) may significantly improve adherence and reduce relapse in patients with psychosis. The aim of this study was to evaluate the relationship between the level of compliance with 1-monthly paliperidone palmitate (PP1M) and hospitalisation rates. Methods: This was a naturalistic, mirror-image study examining retention, compliance and hospitalisation rates 3 years pre- and 3 years post-PP1M initiation. Compliance was divided in three groups: full (no missed dose/year), good (6–11injections/year), poor (<6 injections/year). Results: A total of 173 patients suffering from a severe mental illness (70% with a diagnosis of schizophrenia and 30% with other diagnoses) were included; 77% of patients continued PP1M for 1 year, 66% for 2 years and 55% for 3 years. Of the 95 patients who remained on PP1 throughout the 3 years of follow up, 81% showed full, 13% good, and only 6% poor compliance. In the patients who were fully compliant, the mean number of hospital admissions decreased from 1.34 to 0.43, and the mean number of bed days from 82 to 19 days per patient 3 years before and 3 years after PP1M initiation ( p < 0.001). It is noteworthy that the reductions in hospital stay were statistically significant for the group of patients with full compliance but not for the other two groups. In fact, patients with poor compliance demonstrated higher hospitalisation rates both before and after PPM1 initiation. These findings were similar in the subgroup of patients with schizophrenia who continued treatment for 3 years ( n = 68). Conclusion: There was a direct association between partial compliance and re-hospitalisation; fully compliant patients maintained the best outcomes in terms of reduced bed use following PPM1 initiation.

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