The cost-effectiveness of risperidone long-acting injection in the treatment of schizophrenia

Schizophrenia is an extremely costly disease for families and society owing to the age of onset, chronicity and severity of impact in social, academic and vocational domains. Relapse and often consequent hospitalizations are the most significant healthcare cost drivers, and are closely related to partial- and non-adherence to treatment. Long-acting injections of first-generation antipsychotics or depots were initially developed to attempt to address the adherence problems that are inherent in the treatment of a disorder characterized by difficulties in therapeutic engagement and alliance, as well as impaired insight. Risperidone long-acting injection (RLAI) was the first second-generation antipsychotic available in a long-acting formulation. Determining the pharmacoeconomic benefit of a long-acting injection compared with other treatments is challenging, as there are many different factors and costs involved. Data from pharmacoeconomic modeling, hospitalization, mirror image and other studies suggest that, in general, the greater initial acquisition cost of RLAI is offset by reductions in other domains including hospitalization. However, most of the published studies are open label and are subject to significant selection and sponsor bias. While overall cost-effectiveness in a wide array of different healthcare systems and diverse patient populations has been demonstrated with RLAI, not all studies show a clear benefit. Furthermore, there are unique challenges with RLAI in terms of storage and administration that add to the costs of this treatment.