Real-world effectiveness of long-acting antipsychotic treatments in a nationwide cohort of 3957 patients with schizophrenia, schizoaffective disorder and other diagnoses in Quebec
Bibliographic record
Abstract
Background: Long-acting injectable antipsychotics (LAI-AP) for patients with schizophrenia (SCZ) have saved significant healthcare costs. However, the cost effectiveness of LAI-AP for patients with other mental disorders has yet to be established. The goal of this study was to evaluate the impact of early initiation of LAI-AP medications on healthcare resource utilization (HRU). Drawing on the Quebecois universal healthcare program (RAMQ), we conducted a nationwide prospective cohort study of LAI-AP under real-world conditions. Methods: This study was performed using a representative sample of patients newly treated with LAI-AP ( n = 3957) who were covered by the Québec Health Insurance Plan. The index date was defined as the date of the first prescription for LAI-AP between 1 January 2008 and 31 March 2012. We collected (a) the demographics and patient characteristics; (b) the treatment characteristics index drug, speciality of the principal prescriber, prescriptions of LAI-AP; and (c) HRU and costs. Two comparisons were made between (a) non-SCZ users of LAI-AP and SCZ users of LAI-AP; and (b) patients with SCZ using first-generation antipsychotic LAI-AP (FGA-LAI) and second-generation antipsychotic LAI-AP (SGA-LAI). Results: In the people with SCZ group, 976 patients were on an SGA-LAI, and 1020 patients were on an FGA-LAI; 41.9% of all users were on risperidone LAI-AP during this period and 17.9% were on zuclopenthixol decanoate. The number of hospitalizations was reduced by half. Durations were also significantly reduced. The total healthcare cost savings for all users were C$29,876 per patient/per year. Younger patients tended to receive more SGA-LAI than FGA-LAI: 29% versus 13%. The percentage of general practitioners who prescribe LAI-AP is higher in the FGA-LAI group than in the SGA-LAI group: 19% versus 13%. For psychiatrist prescribers, it is the opposite: 86% (SGA-LAI) versus 79% (FGA-LAI). The concomitant use of oral antipsychotics (OAP) in the year following index date is higher in the FGA-LAI group: 75% versus 43%. The number of hospitalization days was reduced by 31.5 days in the FGA-LAI group and 38.8 days in the SGA-LAI group. Cost savings were of C$31,924 in the FGA-LAI group and of C$39,100 in the SGA-LAI group. Conclusion: The initiation of LAI-AP saved significant costs to the province of Québec compared with the previous year. Initiation of a LAI-AP resulted in lower resource use. Higher medication costs were offset by lower inpatient and outpatient costs.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".