(CSPOT05) Effect of long-acting injectable antipsychotics on treatment adherence and healthcare utilization in Chinese patients with schizophrenia: 1-year mirror-image study

Background: Despite the increase in popularity of long-acting injectables (LAIs) and their promising potential in improving the management of schizophrenia, the current Real-World evidence on the impact of LAIs compared to prior oral antipsychotics (OAPs) in clinical practice among Chinese population is greatly limited.

Objectives: To describe and assess the impact of LAIs on treatment adherence and healthcare utilization in comparison to prior OAPs.

Methods: This is a one-year mirror-image study using electronic medical records (2012-2019) from a psychiatric specialized hospital (PH) and the psychiatry department in a general hospital (GH) in China. Adult patients (aged 18-65) who initiated LAIs after receiving OAPs, with schizophrenia diagnosis at least 12-month before LAI initiation, and received continuous care (at least 4 visits) in the 12 months before and after LAI initiation were included. The date of LAI initiation was designated as the index date. The mirror point was set at the index date for adherence, and 14 days after the index date for healthcare utilization, to account for the hospitalization that may be associated with treatment ineffectiveness of previous medication. Adherence to antipsychotics was assessed by the proportion of days covered (PDC). Schizophrenia-related healthcare utilization comprised the percentage of patients who had admissions, the duration of inpatient stays, the number of inpatient visits, and outpatient visits. Wilcoxon signed-rank test and McNemar’s test were used for before-after comparison.

Results: Overall, 98 (mean age: 33.9 years, male: 45.9%) and 59 (mean age: 24.7 years, male: 49.2%) eligible patients were included in PH and GH, respectively. Compared to the period before LAI initiation, treatment adherence (PDC) increased from 46% to 61% and 32% to 58% (both p<0.01), schizophrenia-related admission rates fell from 10.2% to 4.1% (p=0.11) and 55.9% to 10.2% (p < 0.01), the number of schizophrenia-related inpatient visits reduced from 0.2 to 0.1 per person (p < 0.05) and 0.6 to 0.1 per person (p < 0.01), and the duration of schizophrenia-related inpatient stays decreased from 6 to 2 days and 11 to 2 days (both p<0.01). The number of outpatient visit increased from 5 to 6 per person (p=0.10) and 7 to 9 per person (p < 0.01) in the two hospitals, respectively.

Conclusions: Consistent benefits of LAIs in enhancing treatment adherence and optimizing healthcare utilization were observed in two representative hospitals having different clinical settings and patient characteristics. The observed increase in outpatient visits after LAI initiation indicates that effective treatment encourages patients to return to the hospital, suggesting a potential improvement in patient-doctor collaboration.