Long-Acting Injectable Antipsychotics and Optimization of Schizophrenia Care: A Five-Year Population-Based Study Among Beneficiaries of a Brazilian Health Plan

Abstract

Objectives: Schizophrenia is a chronic psychiatric disorder in which poor treatment adherence is associated with increased relapse rates. Long-acting injectable antipsychotics (LAIs) are intended to improve treatment adherence. This study evaluated healthcare resource utilization and costs among patients with schizophrenia in real-world clinical practice.

Methods: A retrospective study was conducted using data from 2019 to 2024, focusing on beneficiaries diagnosed with mental disorders (ICD-10 F00–F99), particularly schizophrenia (ICD-10 F20–F29). Demographic characteristics, comorbidities, healthcare resource utilization, and associated costs were analyzed. Patients receiving paliperidone palmitate injectable (PP) were compared with those not receiving this medication using appropriate statistical tests; p < 0.05 was considered statistically significant.

Results: Among 60,824 beneficiaries (mean age 54 years; 59.3% female), 4,842 had mental disorders (mean age 52 years; 64.9% female). The prevalence of schizophrenia was 0.22%. The mean annual number of consultations per patient was 6.2, with 0.8 hospitalizations per year. The annual cost of schizophrenia care was US$6,658 per patient, with 75% of this amount attributable to hospitalizations. The daily hospitalization cost was US$420.70. Patients receiving paliperidone palmitate had a hospitalization rate of 0.69 per year and a mean length of stay of 24.3 days, whereas those not receiving the medication had a hospitalization rate of 0.80 per year and a mean length of stay of 37.7 days (p < 0.05).

Conclusions: The use of long-acting injectable antipsychotics reduced both the number and the average duration of hospitalizations, with a reduction of 13 days per hospitalization and a potential cost saving of US$5,469 per patient. These results may enable the reallocation of resources to other interventions and contribute to improved clinical management of patients with schizophrenia.