Evolution of Utilization and Costs of Long-Acting Injectable Antipsychotics (LAIs) in Outpatient Care at Lisbon Psychiatric Hospital (March-May 2022 vs. 2025)
Author(s)
Ana I. Pinto, PhD1, Sara Alexandre, PhD2.
1FARMÁCIA, ULS S. JOSÉ, LISBOA, Portugal, 2FARMÁCIA, ULS S. José, Lisbon, Portugal.
1FARMÁCIA, ULS S. JOSÉ, LISBOA, Portugal, 2FARMÁCIA, ULS S. José, Lisbon, Portugal.
OBJECTIVES: Long-acting injectable antipsychotics (LAIs) have demonstrated benefits in improving treatment adherence, preventing disease progression, reducing relapse rates, and enhancing social functioning. Treatment choice is individualized based on clinical profile, response, tolerability, metabolism, formulation, and patient preference. This study aims to evaluate the evolution of utilization patterns and costs of LAIs at the Lisbon Psychiatric Hospital, now part of the São José Local Health Unit, comparing data from March to May 2022 for the same period in 2025, and to identify pharmacoeconomic impacts related to prescription trends.
METHODS: Utilization data for haloperidol, flupentixol, zuclopentixol, aripiprazole, risperidone, and paliperidone were extracted from the hospital’s medication management system and analyzed in Excel. Defined Daily Doses per 100 outpatients prescribed LAIs (DDD/100UPAPILD) and total costs (€) were calculated. The percentual contribution of each available formulation was also assessed.
RESULTS: There was an overall reduction in DDD/100UPAPILD from 195.0 to 150.43, mainly due to a decrease of first-generation antipsychotics (APILD-1G), both utilization and cost. Although total costs increased from €578,681.16 to €682,565.91, inflation may explain part of this rise. In the 3 months observed, from 2022, APILD-1G predominated, while in 2025 there was a marked shift toward second-generation antipsychotics (APILD-2G). Aripiprazole and risperidone showed increases in both DDD/100UPAPILD and total costs. Risperidone’s fortnightly formulation, dominant in 2022, was surpassed by the monthly version in 2025, which increased costs. Paliperidone usage remained stable, but costs decreased, possibly due to generic availability, as utilization proportions remained similar. Monthly and trimesterly formulations are still the most used, with preference for higher doses.
CONCLUSIONS: There is a clear transition toward APILD-2G, potentially due to new formulations availability with better safety profiles and alignment with national and international guidelines prioritizing adherence and relapse prevention. It would be important to assess the impact of this utilization on clinical progression.
METHODS: Utilization data for haloperidol, flupentixol, zuclopentixol, aripiprazole, risperidone, and paliperidone were extracted from the hospital’s medication management system and analyzed in Excel. Defined Daily Doses per 100 outpatients prescribed LAIs (DDD/100UPAPILD) and total costs (€) were calculated. The percentual contribution of each available formulation was also assessed.
RESULTS: There was an overall reduction in DDD/100UPAPILD from 195.0 to 150.43, mainly due to a decrease of first-generation antipsychotics (APILD-1G), both utilization and cost. Although total costs increased from €578,681.16 to €682,565.91, inflation may explain part of this rise. In the 3 months observed, from 2022, APILD-1G predominated, while in 2025 there was a marked shift toward second-generation antipsychotics (APILD-2G). Aripiprazole and risperidone showed increases in both DDD/100UPAPILD and total costs. Risperidone’s fortnightly formulation, dominant in 2022, was surpassed by the monthly version in 2025, which increased costs. Paliperidone usage remained stable, but costs decreased, possibly due to generic availability, as utilization proportions remained similar. Monthly and trimesterly formulations are still the most used, with preference for higher doses.
CONCLUSIONS: There is a clear transition toward APILD-2G, potentially due to new formulations availability with better safety profiles and alignment with national and international guidelines prioritizing adherence and relapse prevention. It would be important to assess the impact of this utilization on clinical progression.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
RWD80
Topic
Economic Evaluation, Organizational Practices, Real World Data & Information Systems
Disease
Mental Health (including addition)