A Naturalistic Study on the Cost Reduction and Efficacy of Long-acting Antipsychotics in an Early Intervention Programme for Patients with Recent-onset Psychosis

Abstract

Introduction: This study aimed to evaluate the impact of treatment with long-acting injectable antipsychotics on direct healthcare costs in a programme for patients with recent-onset psychosis.

Methods: This was an observational, retrospective study. We included all patients admitted to the programme (from July 2015 to April 2020). All costs were recorded and three groups were compared: those receiving oral antipsychotics; those receiving oral treatment initially but subsequently switching before long-acting injectable antipsychotics; and those receiving after long-acting injectable antipsychotics.

Results: A total of 136 patients were included: 68 patients in the oral antipsychotics group and 34 patients in each of the other two groups. The average total healthcare cost per person/y was €11,347 in the oral antipsychotics group, €49,001 in the before long-acting injectable antipsychotics group, and €27,170 in the after long-acting injectable antipsychotics group. The comparisons between the first group and the other two were significant and between the after long-acting injectable antipsychotics vs before long-acting injectable antipsychotics groups (p<0.01, Mann-Whitney U test). These differences were related to the costs of psychiatric admissions, with an average per person/y of €2,252 (oral antipsychotics group), €22,947 (before long-acting injectable antipsychotics group) and only €777 in the after long-acting injectable antipsychotics group. The only prior clinical or demographic distinction between the three groups was the presence of substance abuse disorder, 41.2% in the oral treatment group vs. 70.6% in the long-acting injectable antipsychotics group (p=0.003 X ² Pearson 99%; confidence interval: 0.002-0.005). In patients with recent-onset psychosis and comorbid substance abuse disorder, treatment with long-acting injectable antipsychotics, despite the higher cost of this medication, may be associated with a reduction in total direct healthcare costs. In our study, it saves €21,831 per patient/y.