Highly Beneficial Antipsychotics Underutilized in People With Schizophrenia

Sanghyuk Seo

Credit: Linkedin

New research has identified widespread underprescription and underutilization of antipsychotics at the cost of clinical and economic outcome improvements in patients with schizophrenia, with second-generation long-acting injectables (SGA LAI) being particularly underutilized.¹

“Differences in antipsychotic prescriptions and healthcare resource utilization (HRU) based on race and ethnicity have been previously identified from real-world studies; however, less is known about the influence of age and insurance coverage on antipsychotic treatment patterns and healthcare resource utilization²,” lead investigator Sanghyuk Seo, former manager, Real-World Value and Evidence, Neuroscience, Janssen, and colleagues wrote. “In order to overcome disparities in care, it is important to understand the contributing or exacerbating factors. To that end, this study examined the impact of race and ethnicity, age, and insurance type on treatment patterns and HRU in a large and diverse population of patients with schizophrenia receiving care in an integrated delivery network (IDN).”

Seo and colleagues conducted a cross-sectional study using electronic health record data from MedStar Health, an IDN in the Baltimore-Washington, DC, area. Data were collected from adult participants had at least 2 outpatient encounters or at least 1 hospitalization with a diagnosis of schizophrenia between January 1, 2017, and March 31, 2021. They assessed outcomes including oral antipsychotic prescriptions, LAI utilization, hospitalizations, emergency department (ED) visits, and outpatient visits. They also conducted subgroup analysis based on age, race/ethnicity, and type of insurance coverage at index (Medicare, Medicaid, and other) over 12 months of follow-up.¹

The investigators found that 78.1% of participants had at least 1 prescription for an antipsychotic and 69.1% received at least 1 second-generation antipsychotic. Only 9.0% received SGA LAI, with patients, with the elderly and Medicaid beneficiaries having the lowest SGA LAI utilization. Prescription and utilization of any antipsychotic, any first-generation antipsychotic (FGA), an oral FGA, an oral SGA, or an SGA LAI decreased with age, while FGA LAI use decreased with age in the 18-to-44-year range but increased in patients aged over the age of 55 years. FGA LAI use was higher among non-Hispanic Black patients (23.7%) compared to non-Hispanic White patients (17.7%; P <.001). Medicare beneficiaries had 20% lower odds of any SGA use compared to Medicaid beneficiaries (OR: 0.80 [95% CI: 0.73–0.88]; P < 0.001).¹

Overall, 61.7% of patients had at least 1 hospitalization, 56.4% had at least 1 outpatient visit, and 50.5% had at least 1 ED visit. Participants aged between 18 and 24 years and those utilizing Medicaid had more hospitalizations, while older patients and those utilizing Medicare had more outpatient visits. After adjusting for age, Medicare beneficiaries had a 26% lower odds of hospitalization than Medicaid beneficiaries (ORa: 0.74 [95% CI: 0.68–0.82]; P < 0.001) and patients with other insurance had a 22% lower odds compared with patients with Medicaid (ORa: 0.78 [95% CI: 0.69–0.89]; P < 0.001).¹

“In conclusion, the results of this study indicate overall underprescription/underutilization of antipsychotic medications, with particularly low use of SGA LAI medications, which have been shown to improve clinical and economic outcomes in patients with schizophrenia. Moreover, disparities in treatment selection and HRU were observed based on age, race/ethnicity, and/or insurance coverage—findings that may influence clinical outcomes for these patients. Education and removal of barriers to healthcare access and treatment are needed to ensure consistent quality of care and reduce the burden of disease in this vulnerable population,” Seo and colleagues concluded.¹

REFERENCES
1. Seo S, Healey BE, McLin R, Sacks NC, Benson CJ, Citrome L. Impact of Demographics and Insurance Coverage on Schizophrenia Treatment and Healthcare Resource Utilization Within an Integrated Healthcare System. Neuropsychiatr Dis Treat. 2024;20:1837-1848. Published 2024 Sep 26. doi:10.2147/NDT.S473492

2. Bareis N, Olfson M, Wall M, Stroup TS. Variation in psychotropic medication prescription for adults with schizophrenia in the United States. Psychiatr Serv. 2022;73(5):492–500. doi: 10.1176/appi.ps.202000932