Presentation (CTI)

OBJECTIVES: Psychotic disorders and intellectual disability (ID) with severe behavioral disturbances (SBD) are associated with substantial clinical and economic burden, driven by poor treatment adherence, recurrent relapses, and frequent hospital use. Long-acting injectable antipsychotics (LAIs) may improve adherence and clinical stability, potentially generating value by reducing high-cost healthcare utilization. Since August 2022, LAIs have been provided free of charge through the Portuguese National Health Service. This study evaluated the impact of LAIs on healthcare utilization and costs from a value-based healthcare perspective.
METHODS: A retrospective pre-post study was conducted among patients with psychotic disorders and ID with SBD who initiated LAI treatment. Emergency department (ED) visits, hospitalizations, and hospitalization days were assessed during the 12 months before and after LAI initiation. Costs were estimated using two complementary approaches: governmental reimbursement sources; hospital analytical accounting data. Descriptive and inferential statistical analyses were performed to evaluate changes in healthcare utilization and costs.
RESULTS: Eighty-one patients were included, of whom 65.4% were male. Schizophrenia spectrum disorders were the most frequent diagnosis (54.3%). Following LAI initiation, significant reductions were observed in ED visits (median change −1.5; p<0.001), hospitalizations (median change −1.0; p<0.001), and hospitalization days (median change −16.5; p<0.001). Using governmental reimbursement sources, treatment costs increased modestly (median change +€985.74; p=0.004). However, analytical accounting demonstrated a significant median reduction in overall healthcare costs of €2,253.69 (95% CI: −€2,984.88 to −€1,763.58; p<0.001), reflecting savings associated with reduced hospital utilization.
CONCLUSIONS: LAI treatment was associated with substantial reductions in acute healthcare utilization, suggesting improved clinical stability and continuity of care. Although medication expenditures increased, reductions in hospital-based resource use generated significant overall cost savings when actual healthcare consumption was considered. These findings support the value proposition of LAIs by demonstrating improved outcomes alongside more efficient use of healthcare resources, consistent with value-based healthcare principles and sustainable mental health service delivery.