title: Impact of switching to long-acting injectable antipsychotics on health services use in the treatment of schizophrenia.
abstract: OBJECTIVE
  To better understand the treatment patterns, persistence and compliance, resource use, and associated costs, of long-acting injectable antipsychotics (LAI-AP), using the Régie de l'assurance maladie du Québec database.
  
  
  METHODS
  Patients with schizophrenia or schizoaffective disorder who were incident users of an LAI-AP prescribed between January 1, 2008, and March 31, 2012, were selected. Concomitant use of oral APs and treatment persistence and compliance with LAI-AP were analyzed. Patients were considered compliant if they had a medication possession ratio (MPR) of at least 0.80. Health care resource use (HCRU) and associated costs were analyzed during the year before and after LAI-AP initiation.
  
  
  RESULTS
  A total of 1992 patients met the inclusion criteria. The average persistence with LAI-AP was 217.2 days (SD 144.2). The mean MPR with LAI-AP during the postinitiation year was 0.58 (SD 0.35), with 37.5% of patients being compliant. In the preinitiation year, 29.0% of patients were compliant with previous oral AP. In the pre- and postinitiation periods, 1484 and 958 patients had at least 1 hospitalization, and hospitalized days were reduced by one-half (P<0.001). Cost of HCRU, including medication, was significantly decreased from $24,382 (SD $27,234) to $13,090 (SD $16,987), respectively, in the pre- and postinitiation years (P<0.001).
  
  
  CONCLUSIONS
  The initiation of an LAI-AP improved treatment compliance, compared with previous oral APs, resulted in significantly lower HCRU and costs. The primary drivers were the reduction in the occurrence and days of hospitalizations.
authors.affiliation: Associate Professor, Faculty of Pharmacy, University of Montreal, Montreal, Quebec.
authors.forename: Jean
authors.initials: J
authors.lastname: Lachaine
authors.affiliation: Research Assistant, Faculty of Pharmacy, University of Montreal, Montreal, Quebec.
authors.forename: Marie-Eve
authors.initials: ME
authors.lastname: Lapierre
authors.affiliation: Market Access Specialist, Lundbeck Canada, Montreal, Quebec.
authors.forename: Nadine
authors.initials: N
authors.lastname: Abdalla
authors.affiliation: Epidemiology Research Manager, Global Epidemiology, Lundbeck SAS, Issy-Les-Moulineaux, France.
authors.forename: Alice
authors.initials: A
authors.lastname: Rouleau
authors.affiliation: Psychiatrist and Professor, Department of Psychiatry, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec; Chair, Department of Psychiatry, Faculty of Medicine, University of Montreal, Montreal, Quebec; Eli Lilly Chair of Schizophrenia, University of Montreal, Montreal, Quebec.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Stip
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003692:Delayed-Action Preparations / Q000627:therapeutic use; D005260:Female; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000191:economics; D011792:Quebec; D012559:Schizophrenia / Q000188:drug therapy* / Q000191:economics; D016903:Drug Monitoring
chemical_list: D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations