title: Impact of atypical long-acting injectable versus oral antipsychotics on rehospitalization rates and emergency room visits among relapsed schizophrenia patients: a retrospective database analysis.
abstract: BACKGROUND
  Among schizophrenia patients relapsed on an oral antipsychotic (AP), this study compared the impact of switching to atypical AP long-acting injectable therapy (LAT) versus continuing oral APs on hospitalization and emergency room (ER) visit recurrence.
  
  
  METHODS
  Electronic records from the Premier Hospital Database (2006-2010) were analyzed. Adult patients receiving oral APs during a schizophrenia-related hospitalization were identified and, upon relapse (i.e., rehospitalization for schizophrenia), were stratified into (a) patients switching to atypical LAT and (b) patients continuing with oral APs. Atypical LAT relapse patients were matched 1:3 with oral AP relapse patients, using a propensity score model. Andersen-Gill Cox proportional hazards models assessed the impact of atypical LAT versus oral AP on time to multiple recurrences of all-cause hospitalizations and ER visits. No adjustment was made for multiplicity.
  
  
  RESULTS
  Atypical LAT (N = 1032) and oral AP (N = 2796) patients were matched and well-balanced with respect to demographic (mean age: 42.1 vs 42.4 years, p = .5622; gender: 43.6% vs 44.6% female, p = .5345), clinical, and hospital characteristics. Over a mean 30-month follow-up period, atypical LATs were associated with significantly lower mean number of rehospitalizations (1.25 vs 1.61, p < .0001) and ER visits (2.33 vs 2.67, p = .0158) compared with oral APs, as well as fewer days in hospital (mean days: 13.46 vs. 15.69, p = .0081). Rehospitalization (HR 0.81, 95% CI 0.76-0.87, p < .0001) and ER visit (HR 0.88, 95% CI 0.87-0.93, p < .0001) rates were significantly lower for patients receiving atypical LAT versus oral APs.
  
  
  CONCLUSIONS
  This hospital database analysis found that in relapsed schizophrenia patients, atypical LATs were associated with lower rehospitalization and ER visit rates than oral APs.
authors.affiliation: Analysis Group, Inc, 111 Huntington Avenue, Tenth Floor, Boston, MA, USA. mduh@analysisgroup.com.
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Lafeuille
authors.forename: François
authors.initials: F
authors.lastname: Laliberté-Auger
authors.forename: Patrick
authors.initials: P
authors.lastname: Lefebvre
authors.forename: Christian
authors.initials: C
authors.lastname: Frois
authors.forename: John
authors.initials: J
authors.lastname: Fastenau
authors.forename: Mei Sheng
authors.initials: MS
authors.lastname: Duh
mesh_terms: D000284:Administration, Oral; D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016208:Databases, Factual; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D018967:Risperidone / Q000008:administration & dosage / Q000627:therapeutic use*; D012559:Schizophrenia / Q000188:drug therapy*
chemical_list: D014150:Antipsychotic Agents; D018967:Risperidone
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