Category: Professional Posters
Purpose: Long-acting injectable (LAI) antipsychotics are frequently used for the maintenance treatment of schizophrenia and other psychotic disorders. Saint Elizabeths Hospital (SEH) Pharmacy conducted medication use evaluations (MUEs) on LAI antipsychotics, then collaborated with hospital committees and Psychiatry team to improve the quality and cost-effectiveness of their use. The Psychiatry team developed and implemented new guidelines for using LAIs. The purpose of this study is to evaluate the LAI use, adverse drug events and cost savings after implementing the new guidance.
Methods: Two pharmacists reviewed all the patients’ chart retrospectively who were treated with LAI antipsychotics during the period of January 1, 2018 – May 31, 2018. The study summary was presented to the P&T Committee and the Medical Staff Leadership Committee in June 2018. Then the Psychiatry team developed the new guidance recommended by the hospital committees and implemented it within June 2018. This was then used to evaluate the impact of guideline implementation, the pharmacy conducted another MUE on LAI antipsychotics during the intervention period of June 1, 2018 – December 31, 2018. LAI antipsychotics use, adverse drug events, LAI cost per patient day and monthly LAI costs were analyzed.
Results: After implementing the new guidelines, the prescribing rate of Risperdal Consta increased while the prescribing rates of Invega Trinza and Sustenna decreased. This change yielded that monthly spending on second generation LAIs decreased from $118,017 to $70,597 during the intervention period.
ADE rates which was calculated as number of reported ADEs that occurred for every 1,000 patient days were 0.33, 0.47, 0.53 and 0.97 in 1Q, 2Q, 3Q and 4Q, respectively. Among them, LAI antipsychotics related ADE rates were 0.12, 0. 0.04 and 0 in 1Q, 2Q, 3Q and 4Q. It implied the new guidance implementation didn’t affect the ADE rates. Psychiatrists did not report significant clinical changes in patients undertaking medicine changes.
Conclusion: Interdisciplinary effort in developing and implementation of new LAI guidance resulted in a 23% reeducation in LAI spending during the seven month study period, with a total cost savings of $331, 932. ADE rates didn’t increase and clinical outcomes were not affected by the shift. This shows that pharmacists play a vital role in taking initiative in improving patient care and saving medication cost. Further studies on LAI antipsychotics and cost effectiveness are needed to assess the long-term outcome.