Cost-consequences analysis of switching from oral antipsychotics to long-acting risperidone in the treatment of schizophrenia

Lack of treatment adherence in schizophrenia often leads to an increase in relapses and, consequentially, to an increase in direct healthcare costs (e.g., hospitalizations). The aim of the SMART study (Schizophrenia Medications Adherence: longacting Risperidone versus other Therapies) was to assess the variation in total direct health-related costs among schizophrenic patients switching from oral antipsychotics to long-acting injectable risperidone (LA-risperidone). Materials and methods A multicentre, retrospective, observational cohort study based on administrative databases from 4 local health units was conducted. Patients with a diagnosis of schizophrenia with a first prescription of LA-risperidone between January 1, 2007 and December 31, 2008 and a previous treatment with oral antipsychotics were enrolled. Direct medical costs (drugs, hospitalizations, Department of Mental Health services, outpatient specialist services) were evaluated during the 12 months preceding and following the date of inclusion (Fig. 1). Results A total of 157 patients were enrolled, 85 males and 72 females, aged 46 ± 14 years (Table I). Total mean disease-related costs per patient were € 5942.54 during the period preceding LArisperidone and € 5385.88 after switching (-€ 556.66, -9.4%) (Table III). The cost increase for antipsychotic drugs (from € 401.78 to € 2356.30, p < 0.001) was offset by a cost reduction for assisted-living (from € 287.61 to € 236.49, p = 0.573), congregate housing (from € 2113.38 to € 1132.48, p = 0.007), Department of Mental Health services (from € 300.30 to € 278.33, p = 0.555) and hospitalizations (from € 2767.26 to € 1313.30, p < 0.001); we registered a decrease in hospital mean length of stay (from 10.6 days to 4.6, p < 0.001) and the number of hospitalizations per patient (from 0.70 to 0.37, p < 0.001); 44% patients were hospitalized during the period preceding LA-risperidone and 20% after switching (Table II). The costs for services unrelated to schizophrenia showed no significant differences (from € 439.54 to € 518.28). The level of treatment adherence increased from 36.4% ± 30.5% to 61.4% ± 30.1% (Fig. 2). Conclusions Therapy with LA-risperidone appears to be cost saving, especially considering the reduction in costs of hospitalizations due to increased adherence.