A Naturalistic Study on the Cost Reduction and Efficacy of Long-acting Antipsychotics in an Early Intervention Programme for Patients with Recent-onset Psychosis

Abstract This study aimed to evaluate the impact of treatment with long-acting injectable antipsychotics on direct healthcare costs in a programme for patients with recent-onset psychosis. This was an observational, retrospective study. We included all patients admitted to the programme (from July 2015 to April 2020). All costs were recorded and three groups were compared: those receiving oral antipsychotics; those receiving oral treatment initially but subsequently switching before long-acting injectable antipsychotics; and those receiving after long-acting injectable antipsychotics. A total of 136 patients were included: 68 patients in the oral antipsychotics group and 34 patients in each of the other two groups. The average total healthcare cost per person/y was €11,347 in the oral antipsychotics group, €49,001 in the before long-acting injectable antipsychotics group, and €27,170 in the after long-acting injectable antipsychotics group. The comparisons between the first group and the other two were significant and between the after long-acting injectable antipsychotics vs before long-acting injectable antipsychotics groups (p<0.01, Mann–Whitney U test). These differences were related to the costs of psychiatric admissions, with an average per person/y of €2,252 (oral antipsychotics group), €22,947 (before long-acting injectable antipsychotics group) and only €777 in the after long-acting injectable antipsychotics group. The only prior clinical or demographic distinction between the three groups was the presence of substance abuse disorder, 41.2% in the oral treatment group vs. 70.6% in the long-acting injectable antipsychotics group (p=0.003 X 2 Pearson 99%; confidence interval: 0.002–0.005). In patients with recent-onset psychosis and comorbid substance abuse disorder, treatment with long-acting injectable antipsychotics, despite the higher cost of this medication, may be associated with a reduction in total direct healthcare costs. In our study, it saves €21,831 per patient/y.