Hospitalisation Utilisation and Costs in Schizophrenia Patients in Finland before and after Initiation of Risperidone Long-Acting Injection

Objectives. Quantify changes in hospital resource use in Finland following initiation of risperidone long-acting injection (RLAI). Materials and Methods. A retrospective multi-center chart review (naturalistic setting) was used to compare annual hospital bed-days and hospital episodes for 177 schizophrenia patients (mean age 47.1 years, 52% female, 72% hospitalized) before and after initiation of RLAI (between January 2004 and June 2005) using the within-patient “mirror-image” study design. The base case analytical approach allocated hospital episodes overlapping the start date entirely to the preinitiation period. In order to investigate the impact of inpatient care ongoing at baseline, the change in bed-days was also estimated using an alternative analytical approached related to economic modelling. Results. In the conventional analysis, the mean annual hospitalisation costs declined by €11,900 and the number of bed-days was reduced by 40%, corresponding to 0.19 fewer hospital episodes per year. The reductions in bed-days per patient-year were similar for patients switched to RLAI as inpatients and as outpatients. In the modelling-based analysis, an 8% reduction in bed-days per year was observed. Conclusion. Despite uncertainty in the choice of analytic approach for allocating inpatient episodes that overlapping this initiation, consistent reductions in resource use are associated with the initiation of RLAI in Finland. 1. Introduction Schizophrenia is a serious mental illness causing significant social or occupational dysfunction. With an annual global incidence of 8 to 40 individuals per 100,000 per year [1], the total costs of treating schizophrenia are high [2] and may be as much as 3% of all health expenditures [3]. Most of the direct costs of schizophrenia (79%) result from hospitalisation or other residential care [3], thus a principal aim of treatment in schizophrenia patients is to prevent relapse, reduce the requirements for in-hospital treatment, and enable patients to lead near-normal lives. Pharmacological treatments for schizophrenia have been available since the mid-1950s. The first class of medication, “typical antipsychotics,” is effective at treating psychotic symptoms but, while still used widely, is associated with problematic extrapyramidal side effects. The second generation of drugs, “atypical antipsychotics,” became available in the 1990s and may cause fewer extrapyramidal side effects, though medication noncompliance continues to be common in schizophrenia patients in part because of serious metabolic concerns. Long-acting