The cost associated with administering risperidone long-acting injections in the Australian community

Abstract

BackgroundRisperidone long-acting injection (LAI) is mostly administered twice weekly to people with schizophrenia by nurses at community mental health centres (CMHC) or through mobile outreach visits. This study estimates the cost of resource utilisation associated with the administration of risperidone LAI and the potential savings from substituting two-weekly injections with a longer interval product of therapeutic equivalence.MethodsA survey of mental health staff overseeing the administration of risperidone LAI at 253 distinct Australian CMHCs was undertaken in November 2009. For the two-week period prior to the survey, respondents were asked questions on injection time (and related tasks) and, for mobile outreach visits, distance and time travelled as well as reduction in visits. Results were stratified by Australian Standard Geographical Classification (ASGC) region. Resource use was quantified and valued in Australian dollars.ResultsResults are derived from 74 CMHCs, representing approximately 26% of the national average risperidone LAI unit two-week sales. Stratified average injection time (including related tasks) for risperidone LAI ranged from 18-29 minutes, with a national average of 20.12 minutes. For mobile outreach visits, average distance per patient ranged from 19.4 to 55.5 km for One Staff Visits and 15.2 to 218.1 km for More Than One Staff Visits, and average time travelled ranged from 34.1 to 54.5 minutes for One Staff Visits and 29.2 to 136.3 minutes for More Than One Staff visits. The upper range consistently reflected greater resource utilisation in rural areas compared to urban areas. If administration of risperidone LAI had not been required, 20% fewer mobile outreach visits would have occurred.ConclusionsThe national average saving per two-weekly risperidone long-acting injection avoided is $75.14. In 2009 in Australia, this would have saved ~$11 million for injection administration costs alone if all patients taking two-weekly risperidone LAI had instead been treated with a therapeutically equivalent long-acting injectable antipsychotic requiring one less injection per month.

A systematic review and meta-analysis of the effect of depot antipsychotic frequency on compliance and outcome

“…Additionally, in one study, risperidone produced greater improvement in PANSS scores (Li et al, 2011). There were no RCT data on cost-effectiveness, the literature being based on industryfunded economic modelling (Dalton et al, 2011;Mehnert et al, 2012;Zeidler et al, 2013).…”

“…An industry-sponsored cost analysis of potential savings from changing from a two-weekly to monthly regime estimated an average saving of US$58 per injection avoided, potentially saving US$8.5 million per year (Dalton et al, 2011). In addition, this might give staff more time for other duties, and be more convenient for patients.…”

Does the frequency of administration of long acting injectable antipsychotics impact psychiatric outcomes and adverse effects: A systematic review and meta-analysis

“…ITT analyses were largely limited to the assessment of secondary outcome measures, such as ADRs. In the case of the study with the lowest follow-up (Fleischhacker et al, 2012), the results of ITT analyses for primary outcomes were not disclosed, but were reported to be similar to the per-protocol analyses. Hence, this study was rated as high risk for selective reporting (Table S1).…”

“…Four studies had a follow-up rate of between 75% to 85% (Li et al, 2011;Mi et al, 2010;Pandina et al, 2011;Savitz et al, 2017;Savitz et al, 2016). One paper had a follow-up of 73% (Risinger et al, 2017), whilst the final study had a follow-up of only 45% (Fleischhacker et al, 2012). Six of the papers reported both per-protocol and intention-totreat (ITT) analyses but most studies have a greater focus on per-protocol analyses rather than ITT analyses.…”

“…The one study that reported on hospitalisation rates found no significant differences between one-monthly and three-monthly paliperidone (RR = 1.29 [95% CI = 0.68, 2.42]) (Savitz et al, 2017;Savitz et al, 2016). Four studies reported on relapses of psychosis while on LAIs, with three of these studies comparing 2-weekly versus 4-weekly injections (Fleischhacker et al, 2012;Lauriello et al, 2008;Pandina et al, 2011). Meta-analyses showed no difference in relapse rates between 2-weekly injections versus 4-weekly injections (Fig.…”