Inpatient resource use and costs associated with switching from oral antipsychotics to aripiprazole once-monthly for the treatment of schizophrenia

Article Details

Authors
Michele Wilson, Benjamin Gutierrez, Steve J Offord, Christopher M Blanchette, Anna Eramo, Stephanie Earnshaw, Siddhesh A Kamat

Article Type
Original Research

DOI
10.7573/dic.212273

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Abstract

Background: Schizophrenia is associated with high direct healthcare costs due to progression of disease and frequent occurrence of relapses. Aripiprazole once-monthly (AOM) has been shown to reduce total psychiatric hospitalizations among patients who switched from oral standard of care (SOC) therapy to AOM in a multicenter, open-label, mirror-image study of patients with schizophrenia. Because of the increasing need to improve patient outcomes while containing costs, it is important to understand the impact of AOM treatment initiation on medical costs associated with psychiatric hospitalizations and antipsychotic pharmacy costs.

Methods: In the current study, an economic model was developed using data from the AOM mirror-image study to evaluate the psychiatric hospitalization-related medical costs and antipsychotic pharmacy costs during a 6-month period before (retrospective period) and after (prospective period) the AOM treatment initiation. The economic model evaluated cost-saving potential of AOM among all patients (n=433) as well as a subset of patients with ≥1 prior hospitalization (n=165) who switched from oral SOC to AOM. Unit cost data were obtained from publicly available sources.

Results: Both hospitalizations and hospital days were reduced following a switch from oral SOC to AOM. As a result, psychiatric hospitalization-related costs were lower during the prospective period when compared with the retrospective period. Furthermore, the increase in antipsychotic pharmacy costs due to switching from oral SOC to AOM was offset by a reduction in psychiatric hospitalization-related medical costs. Per-patient costs were reduced by $1,046 (USD) in the overall population and by $20,353 in a subset of patients who had at least 1 psychiatric hospitalization during the retrospective period. Results were most sensitive to changes in hospitalization costs.

Conclusions: AOM is associated with reducing the risk of relapse among patients with schizophrenia. The increase in antipsychotic pharmacy costs due to switching from oral SOC to AOM was offset by a reduction in costs associated with psychiatric hospitalizations, thereby presenting a cost-saving opportunity for health plans.

Keywords: schizophrenia, long-acting injectable, economic model, aripiprazole once-monthly, relapse, healthcare cost.

Abbreviations: AOM, aripiprazole once-monthly; HCUP, Healthcare Cost and Utilization Project; HEDIS, Healthcare Effectiveness Data and Information Set; ICER, incremental cost-effectiveness ratio; LAI, long-acting injectable; LOS, length of stay; P, prospective; R, retrospective; SOC, standard of care.

Citation: Wilson W, Gutierrez B, Offord SJ, Blanchette CM, Eramo A, Earnshaw S, Kamat SA. Inpatient resource use and costs associated with switching from oral antipsychotics to aripiprazole once-monthly for the treatment of schizophrenia.  Drugs in Context 2016; 5: 212273. DOI: 10.7573/dic.212273

Contributions: Michele Wilson, Siddhesh A. Kamat, Benjamin Gutierrez, Steve J. Offord, and Stephanie Earnshaw contributed to the conception and design of this study. This study’s statistical analyses were made by Michele Wilson; supervisory contributions were made by Siddhesh A. Kamat, Steve J. Offord, Anna Eramo, and Stephanie Earnshaw; and contributions related to administrative, technical, or material support were made by Christopher M. Blanchette. Michele Wilson, Anna Eramo, and Siddhesh A. Kamat contributed to the acquisition of data, and all authors contributed to the analysis and interpretation of the data as well as the writing, review, and revision of the manuscript.

Potential conflicts of interest: Michele Wilson and Stephanie Earnshaw are employees of RTI Health Solutions, which receives funding from pharmaceutical, biotechnology, and medical device/diagnostic companies that develop healthcare technologies, including funding from Otsuka America Pharmaceutical, Inc., to perform the research for this and other projects. Steve J. Offord and Siddhesh A. Kamat are employees of Otsuka America Pharmaceutical, Inc., and Benjamin Gutierrez and Christopher M. Blanchette were employed at Otsuka America Pharmaceutical, Inc. at the time the study was performed. Anna Eramo is an employee of Lundbeck. The International Committee of Medical Journal Editors’ (ICMJE) potential Conflicts of Interests form for the author is available for download at: https://www.drugsincontext.com/wp-content/uploads/2016/03/dic.212273-COI.pdf.

Funding declaration: This study was sponsored by Otsuka America Pharmaceutical, Inc., Princeton, NJ, USA; Otsuka Pharmaceutical Development and Commercialization, Inc., Princeton, NJ, USA; and Lundbeck LLC., Deerfield, IL, USA. Medical writing and editorial support for the preparation of this manuscript was provided by Scientific Connexions, Lyndhurst, NJ, USA, an Ashfield company, part of UDG Healthcare plc, funded by Otsuka America Pharmaceutical, Inc., Princeton, NJ, USA, and Lundbeck LLC., Deerfield, IL, USA.

Acknowledgments: The authors would like to thank Ross A. Baker, Otsuka Pharmaceutical Development and Commercialization, Inc., for his contributions to this study. The authors would also like to acknowledge Scientific Connexions for their assistance in the preparation of this manuscript for submission.

Copyright: Copyright © 2016 Wilson W, Gutierrez B, Offord SJ, Blanchette CM, Eramo A, Earnshaw S, Kamat SA. Distributed under the terms of the Creative Commons License Deed CC BY NC ND 3.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2016 Wilson W, Gutierrez B, Offord SJ, Blanchette CM, Eramo A, Earnshaw S, Kamat SA. http://dx.doi.org/10.7573/dic.212273. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 3.0.

Article URL: https://drugsincontext.com/inpatient-resource-use-and-costs-associated-with-switching-from-oral-antipsychotics-to-aripiprazole-once-monthly-for-the-treatment-of-schizophrenia

Correspondence: Siddhesh Kamat, MS, MBA, Health Economics & Outcomes Research, Otsuka America Pharmaceutical, Inc., 508 Carnegie Center, Princeton, NJ 08540, USA. Siddhesh.Kamat@otsuka-us.com

Provenance: Submitted; externally peer reviewed

Submitted: 10 December 2014; Peer review comments to author: 5 January 2015; Published: 11 March 2016

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