See letter by Stip, reply by Correll et al, and article by Correll et al

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Cost Reductions Associated With Long-Acting Injectable Antipsychotics According to Patient Age

To the Editor: In their interesting and didactic article, Correll et al state, “The cost of LAIs [long-acting injectable antipsychotics] presents a barrier to their use. However…they may save money across the entire continuum of care.”1(19) Like other Canadian provinces, Quebec has a universal health care program that covers physician services and hospitalizations for the entire population (Régie de l’assurance maladie du Québec [RAMQ]). This universal health program is complemented, for a large proportion of the population, by a public drug plan. The provincial drug reimbursement program covers all people 65 years and older, beneficiaries of the social assistance program (including individuals with schizophrenia), and individuals who do not have access to a private medication insurance plan. The RAMQ medical services database contains information from physicians’ claims for services provided within and outside the hospital. The RAMQ pharmaceutical services database includes information from pharmacists’ claims for dispensed medication reimbursed by the program but not for medication received in a hospital. In addition, the program includes an encrypted patient identifier, which enables linkage of individual patient information while preserving anonymity.

A previous study from Quebec, Canada, evaluated the impact of switching to LAIs on health services use in the treatment of schizophrenia.2,3 More recently, again using the Quebec drug plan database, my colleagues and I selected patients with schizophrenia who were incident users of LAIs between January 2008 and March 2012. The objective was to evaluate the impact of these medications on health care resource utilization (HCRU) in different age groups of patients with schizophrenia. HCRU and associated costs were analyzed during the year before and after LAI initiation, using 5 age groups: < 30, 30–39, 40–49, 50–59, and ≥ 60 years.

The study included 1,996 schizophrenia patients, and their mean age was 43.4 years (SD = 14.5). The mean reductions in hospitalization days and total HCRU costs from the year before to the year after initiation of LAI treatment were 35.1 days (95% CI, 32.0–38.2) and CAD $33,477 (95% CI, 30,347–36,607), respectively (Table 1). Similar reductions in hospitalization days and total HCRU costs were observed across all age groups. In the pre-initiation period, the mean costs associated with the total HCRU were higher among patients younger than 30 years (CAD $69,915) compared to those aged 30 years and over (CAD $54,529) (P .01).

Table 1

Click figure to enlarge

This analysis revealed that initiation of LAI treatment was associated with a significant reduction in HCRU in all age groups. Further, in the year before initiation of LAI treatment, costs were higher in younger patients than in older patients.

References

1. Correll CU, Citrome L, Haddad PM, et al. The use of long-acting injectable antipsychotics in schizophrenia: evaluating the evidence. J Clin Psychiatry. 2016;77(suppl 3):1–24. PubMed doi:10.4088/JCP.15032su1

2. Lachaine J, Lapierre ME, Abdalla N, et al. Impact of switching to long-acting injectable antipsychotics on health services use in the treatment of schizophrenia. Can J Psychiatry. 2015;60(suppl 2):S40–S47. PubMed

3. Lachaine J, Larbi M, Melnyk P, et al. Impact of initiation of long-acting injectable antipsychotics on resource utilization in patients with schizophrenia. Value Health. 2016;19(7):A605. doi:10.1016/j.jval.2016.09.1489

Emmanuel Stip, MD, MSca

emmanuel.stip@umontreal.ca

aDepartment of Psychiatry, Centre Hospitalier de l’Université de Montréal; and Department of Psychiatry, Hôpital Notre-Dame–Pavillon L. C. Simard, Montreal, Quebec, Canada

Potential conflicts of interest: None.

Funding/support: RAMQ data were obtained with funding from Lundbeck and Otsuka Canada.

J Clin Psychiatry 2017;78(8):e1061

https://doi.org/10.4088/JCP.16lr11402

© Copyright 2017 Physicians Postgraduate Press, Inc.