LONG-ACTING INJECTABLE ANTIPSYCHOTICS (LAI) IN HOSPITALIZED PATIENTS WITH SCHIZOPHRENIA SPECTRUM DISORDERS: PRELIMINARY ANALYSIS AND PROJECTION OF DRUG-ECONOMIC VARIABLES (BUDGET-IMPACT).

AUTHORS Sabrina Laurenzi, MD*, Sandra Ramacciotti, MD*, Vincenzo Matera, MD*, Stefano Nassini, MD*.

*Unità Operativa Complessa di Psichiatria, ASUR Marche Area Vasta 3, Sede di Civitanova Marche. Tel. +39 0733 823290; Fax +39 0733 823301; mail: sabrina.laurenzi@sanita.marche.it

IV Incontro Nazionale dei Giovani Psichiatri, PSICOPATOLOGIA, FARMACOLOGIA E NEUROSCIENZE: INCONTRI POSSIBILIRoma 5-6 Maggio 2016

BACKGROUND AND AIM OF THE STUDYPharmaco-economic evaluations are fundamental to assess validity of drug treatments in clinical practice along with efficacy and effectiveness data. However, direct costs due to pharmacological treatments are only a part of the economic burden of Schizophrenia.Schizophrenia Spectrum Disorders are mental illness that causes considerable costs to society. The high costs are mainly due to the early age of onset with many patients affected during their entire lifetime with negative effects on their working ability and limited opportunities with regard to the labour market (so called, indirect costs). Relapses, subsequent hospitalizations and therapeutic residential programs have been identified as another significant cost driver. Hospitalizations in turn are caused by a poor adherence to antipsychotic medication. In this context, it has been discussed whether the treatment with Long-Acting Injectables antipsychotics (LAIs) can be a cost-effective strategy to reduce overall health care costs. The aim of this study is to evaluate the impact of using LAI antipsychotics in term of direct cost in DSM budget so to confirm the sustainability of these drugs.

RESULTSAntipsychotics LAI represent a high percentage of pharma-cological budget (70.3% in 2014 and 70.4% in 2015) of our Psychiatric Unit. Pharmacological budget covers pharma-cological expenditures during hospitalizations and NHS H-Code drugs (LAI antipsychotics in this case) that are directly administered from NHS hospitals to outpatients. The course of illness of 25 subjects treated with an-tipsychotics LAI (15 male and 10 female, average age 38,7 years) shows a clear reduction of number of hospitalization and, most of all, of days of hospitalization (315 vs 193 total days). Thus the saving is 122 days that in economic terms covers 52,9 % of the total increased costs due to AP LAI use when calculating cost of a day of hospitalization as Hospi-tal’s DRG income vs mean duration of hospitalization in Italy. A global saving of 230,59 hospitalization days would be enough to guarantee the sustainability of this treatment only by reducing direct costs of hospitalizations.

METHODSIn this study we analysed budget impact and direct costs of pharmacological treatment with LAI antipsychotics on a Psychiatric Unit (Unità Operativa Complessa di Psichiatria) budget during 2014 and 2015.Further economic considerations had been derived from the analysis of the data of the outcomes of a clinical study on 25 subjects (15 male and 10 female, mean age 38,7 years) affected by Schizophrenia Spectrum Disorders treated with LAI antipsychotics in a mirror image designed study. The course of the illness was assessed by comparing days and number of hospitalizations over a period of one year.

CONCLUSIONSLAI Antipsychotics, according to literature, are highly effective in modifying the course of schizophrenic disorder. Their economic impact could be sustained by costs reduction for hospitalization in acute ward. Indirect cost reductions of Schizophrenia Spectrum Disorders will surely provide a further economic advantage in managing these severe and high disabling illness.

REFERENCES 1. Mental Health Policy and Practice across Europe. The future direction of mental health care. Edited by Martin Knapp, David McDaid, Elias Mossialos and Graham Thornicroft. 2007.2. Evanthia Achilla • Paul McCrone. The Cost Effectiveness of Long-Acting/Exten-ded-Release. Antipsychotics for the Treatment of Schizophrenia. Appl Health Econ Health Policy (2013) 11:95–106.3. Roberto Ravasio, Giuseppe Nicolò, Marco Vaggi. Analisi di costo efficacia di paliperidone palmitato rispetto a risperidone a rilascio prolungato nel trattamento di mantenimento dei pazienti affetti da schizofrenia in Italia. Global & Regional Health Technology Assessment 2015; 2 (1): 17-32.

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Unità Operativa Complessa di Psichiatria, ASUR Marche Area Vasta 3, Sede di Civitanova Marche - Tel. +39 0733 823290 - Fax +39 0733 823301 - mail: sabrina.laurenzi@sanita.marche.it