Gesundheitsökonomie & Qualitätsmanagement 2020; 25(03): 170-178
DOI: 10.1055/a-1167-6057
Originalarbeit

Short-acting antipsychotics or long-acting injectables? A treatment comparison in patients with schizophrenia

Kurzwirksame Antipsychotika oder Depot-Injektionen? Ein Vergleich der Behandlung von Patienten mit Schizophrenie
Helena Thiem
1   Institute of Empirical Health Economics, Burscheid, Germany
,
Here Folkerts
2   Klinikum Wilhelmshaven, Germany
,
Lukas Völkel
1   Institute of Empirical Health Economics, Burscheid, Germany
› Author Affiliations

Abstract

Aim This research aims to compare the efficacy and direct costs of short-acting oral antipsychotics and aripiprazole once-monthly (AOM) in the context of the treatment of patients with schizophrenia based on real-world data in Germany.

Method Results are based on a single-armed, retrospective, non-interventional pre-post comparison study evaluating data from 132 patients with schizophrenia before and after switching from oral antipsychotics to AOM treatment (6 months each). Socio-demographics, as well as parameters of indication, efficacy and resource consumption were analyzed and statistically evaluated.

Results The switch from an oral antipsychotic medication to AOM led to a distinct improvement in all clinically relevant parameters, including a reduction in hospitalization rates (55.1 % vs. 14.0 %), length of stay (43.5 d vs. 34.8 d) and percentage of patients with multiple hospitalizations (13.6 % vs. 3.8 %). There was also a reduction in schizophrenic episodes for patients with ≥ 1 episode (2.9 vs. 1.4) and of the percentage of patients with ≥ 1 (88.0 % vs. 29.3 %) as well as ≥ 2 (60.0 % vs. 8.1 %) schizophrenic episodes. The proportion of patients requiring a visit to day clinics or psychiatric institute outpatient clinics (PIA) decreased (39.5 % vs. 8.4 %) for patients with AOM treatment, as did the average length of stay in day clinics or PIAs (116.8 d vs. 86.4 d) for patients with ≥ 1 stay. The cost saving potential of AOM compared to the treatment with oral antipsychotics ranged between 1,729.32 € and 5,048.53 € per patient for a six-month observation period.

Conclusion Our results suggest that AOM treatment of patients with schizophrenia is more effective (reduction in schizophrenic episodes, hospitalizations, stays in day clinics, psychiatrist visits, losses in productivity) and generates lower costs for the statutory health insurance (SHI) in Germany than treatment with oral antipsychotics and should therefore not be regarded as only a last-resort treatment option for schizophrenia.

Zusammenfassung

Zielsetzung Auf Grundlage von Versorgungsdaten aus Deutschland sollen die Wirksamkeit und die direkten Kosten von kurzwirksamen oralen Antipsychotika und Aripiprazol-Depot im Rahmen der Behandlung von Patienten mit Schizophrenie bewertet werden.

Methodik Die Ergebnisse basieren auf einer einarmigen, retrospektiven, nicht-interventionellen Prä-Post-Vergleichsstudie, in der Daten von 132 Patienten mit Schizophrenie vor und nach dem Wechsel von oralen Antipsychotika zu Aripiprazol-Depot (jeweils 6 Monate) ausgewertet wurden. Soziodemographie, indikations- und wirksamkeitsbasierte Parameter sowie Parameter des Ressourcenverbrauchs wurden analysiert und statistisch ausgewertet.

Ergebnisse Die Umstellung von einem oralen antipsychotischen Medikament auf Aripiprazol-Depot führte zu einer deutlichen Verbesserung aller klinisch relevanten Parameter, darunter eine Senkung der Krankenhausraten (55,1 % vs. 14,0 %), der Verweildauer (43,5 Tage vs. 34,8 Tage) und des Anteils von Patienten mit mehrfachen Krankenhausaufenthalten (13,6 % vs. 3,8 %). Auch bei der Anzahl an Patienten mit ≥ 1 schizophrenen Episode (2,9 vs. 1,4) und beim Anteil der Patienten mit ≥ 1 (88,0 % vs. 29,3 %) sowie ≥ 2 (60,0 % vs. 8,1 %) schizophrenen Episoden wurde eine Reduktion festgestellt. Der Anteil der Patienten, die einen Aufenthalt in einer Tagesklinik oder einer psychiatrischen Ambulanz benötigten, ging zurück (39,5 % vs. 8,4 %); die durchschnittliche Aufenthaltsdauer in einer Tagesklinik oder psychiatrischen Ambulanz sank bei Patienten mit ≥ 1 Aufenthalt (116,8 d vs. 86,4 d). Das Kosteneinsparpotenzial von Aripiprazol-Depot im Vergleich zur Behandlung mit oralen Antipsychotika lag über einen 6-monatigen Beobachtungszeitraum zwischen 1.729,32 € und 5.048,53 € pro Patient.

Schlussfolgerung Unsere Ergebnisse deuten darauf hin, dass die Aripiprazol-Depot-Behandlung von Patienten mit Schizophrenie eine höhere Effektivität (Reduktion von Schizophrenie-Episoden, Aufenthalten in Krankenhaus, Tagesklinik oder Psychiatrie sowie Produktivitätsverlusten) aufweist und aus Sicht der gesetzlichen Krankenkasse (GKV) in Deutschland geringere Kosten verursacht als die Behandlung mit oralen Antipsychotika. Die Therapie sollte daher nicht ausschließlich als letztmögliche Behandlungsoption für Schizophrenie angesehen werden.



Publication History

Article published online:
13 May 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 
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