OBJECTIVES: The use of long-acting injectable antipsychotics (LAIs) is considered an important option in the management of schizophrenia, as their pharmacokinetics offer considerable advantages in terms of compliance and drug plasma level compared with oral antipsychotics (OAPs).

AIM: To investigate factors affecting the efficacy of antipsychotics in terms of relapse prevention in the real-world and to estimate their real-life impact in terms of overall disease management cost.

METHODS: We conducted a literature search using MEDLINE/PubMed with the aim of extracting efficacy and effectiveness data of LAIs and OAPs. The primary outcome was relapse rate (RR). RRs reported from RCTs and low risk of bias observational studies were pooled and analyzed in a Bayesian hierarchical model in order to estimate the real-world effectiveness of relapse prevention as function of antipsychotic generation (second- vs. first-generation, SGA vs. FGA), administration route (parenteral vs. oral) and frequency. Resulting estimates were used as inputs for an economic evaluation of the management costs of schizophrenia from the Italian NHS perspective.

RESULTS: 50 studies reporting on 71 direct comparisons met inclusion criteria. The model estimates indicate increasing effectiveness with LAIs vs. OAPs, SGAs vs. FGAs, and lower administration frequency. The lowest RR is predicted for SGA LAIs administered once every 3 or 6 months, with relative reductions of 77% and 83% compared to FGA OAPs. Economic evaluation results show that the least expected cumulative cost is associated to SGAs administered every 180 days, with an overall cost reduction of more than € 2,000 per patient at 1 year, if compared to FGA OAPs.

CONCLUSIONS: In the Italian setting, SGA LAIs administered every 180 days are expected to be the a high value option for the treatment of patients with schizophrenia from both the clinical and economic perspectives.