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The Journal of Clinical Psychiatry

Original Research October 21, 2026

From Hospital to Outpatient Care After Long-Acting Injectable Antipsychotic Initiation in Bipolar Disorder: Nationwide Evidence From Taiwan

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J Clin Psychiatry 2026;87(4):26m16479

Abstract

Objective: Second-generation long-acting injectable antipsychotics (SGA-LAIs) are increasingly used in bipolar disorder (BD), yet population-level evidence is limited on whether LAI initiation is associated with changes in real-world health care utilization that may reflect improved continuity of care within single-payer systems.

Methods: We conducted a nationwide retrospective mirror-image study using Taiwan’s National Health Insurance data. Individuals with BD who initiated an SGA-LAI between 2015 and 2024 were identified. Psychiatric outpatient visits and expenditures, emergency department (ED) visits and expenditures, inpatient admissions, length of stay, and inpatient expenditures were compared during the 12 months before and after the index injection. Stable use was defined as meeting or exceeding label-specified injection frequency for at least 12 months and was analyzed as an implementation-oriented indicator of sustained engagement with LAI-based care.

Results: Among 17,513 SGA-LAI initiators, 2,937 met analytic criteria for BD, and 500 stable users were included in the final utilization and cost analyses. After SGA-LAI initiation, both stable and nonstable users showed increased psychiatric outpatient engagement and higher outpatient expenditures, together with reduced ED utilization and lower inpatient use. The shift from acute to ambulatory care was greater among stable users.

Conclusion: In BD patients within Taiwan’s single-payer system, SGA-LAI initiation was associated with a shift from acute-care utilization toward ambulatory follow-up. Differences by stable use or LAI agent should be interpreted as implementation-related patterns of sustained engagement with LAI-based care, rather than as a direct head-to-head comparison of pharmacologic efficacy or evidence of superior intrinsic drug effects. Reduced acute-care use may suggest less relapse-related service use, but relapse was not directly measured.

J Clin Psychiatry 2026;87(4):26m16479

Author affiliations are listed at the end of this article.

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