title: Hospitalization resource utilization and costs among Medicaid insured patients with schizophrenia with different treatment durations of long-acting injectable antipsychotic therapy.
abstract: This study evaluated the impact of using long-acting injectable (LAI) antipsychotics for a longer treatment duration versus a short duration on health care resource utilization among Medicaid-insured schizophrenia patients. Schizophrenia patients 13 years or older initiating LAI antipsychotics were identified from the Truven Health Analytics MarketScan Research Medicaid database between July 1, 2005, and June 30, 2010. The study population was grouped into 2 study cohorts (longer-usage-duration cohort: ≥ 180 days of supply and short-usage-duration cohort: <180 days of supply). Hospitalization-related resource utilization and costs were determined during a variable follow-up period and compared at the unadjusted and adjusted levels. Of the 5694 patients identified, 2838 patients were treated with LAI antipsychotics for a mean duration of 604 (SD, 432) days (mean age, 38.91 years), and 2856 were treated for 86 (SD, 43) days (mean age, 39.96 days). Total hospital lengths of stay, all cause (6.56 [SD, 18.63] vs 4.93 [SD, 13.40] days, P < 0.001) and schizophrenia related (5.18 [SD, 14.96] vs 4.16 [SD, 11.94] days, P = 0.005), and the mean number of hospitalizations, all cause (0.79 [SD, 1.78] vs 0.61 [SD, 1.41], P < 0.001) and schizophrenia related (0.63 [SD, 1.55] vs 0.51 [SD, 1.26], P = 0.001), were lower for the longer-usage-duration cohort. Cox regression results showed that using LAI antipsychotics for a longer duration was correlated with longer time to the first hospitalization for any cause and for schizophrenia. After multivariate regression, longer usage duration of LAI antipsychotics was associated with a decreased number of hospitalizations (-0.15 per year, P < 0.001), a decreased hospital length of stay (-1.50 days, P < 0.001), and reduced hospital payment (-26%, P < 0.001). Patients who are treated with LAI antipsychotics for a longer versus shorter duration use hospital resources less.
authors.affiliation: From the *University of California, Irvine, School of Medicine, Orange, CA; †Otsuka America Pharmaceutical, Inc, Princeton; ‡Novosys Health, Flemington, NJ; and §CNK Consultants, Wayne, PA.
authors.forename: Rimal
authors.initials: R
authors.lastname: Bera
authors.forename: Steve
authors.initials: S
authors.lastname: Offord
authors.forename: Donna
authors.initials: D
authors.lastname: Zubek
authors.forename: Gina
authors.initials: G
authors.lastname: Lau
authors.forename: Jay
authors.initials: J
authors.lastname: Lin
authors.forename: Craig
authors.initials: C
authors.lastname: Karson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000191:economics*; D016009:Chi-Square Distribution; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003692:Delayed-Action Preparations; D004334:Drug Administration Schedule; D016527:Drug Costs; D005260:Female; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data; D017721:Hospital Costs; D006801:Humans; D007267:Injections; D007902:Length of Stay / Q000191:economics; D016014:Linear Models; D008297:Male; D008484:Medicaid / Q000191:economics*; D008875:Middle Aged; D018803:Models, Economic; D015999:Multivariate Analysis; D010343:Patient Admission / Q000191:economics*; D010359:Patient Readmission / Q000191:economics; D010818:Practice Patterns, Physicians' / Q000191:economics; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D012565:Schizophrenic Psychology; D013997:Time Factors; D014481:United States; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations