Background and Importance The effectiveness of second generation antipsychotics (SGA) has been shown to be equivalent to the first-generation antipsychotics (FGA), with different side effect profiles.

Aim and Objectives The aim of this study was to determine the patterns of antipsychotics prescription and related costs at a university hospital.

Material and Methods One year retrospective observational study at a Spanish university general hospital. Identification of outpatients under treatment with antipsychotics during 2021, which had been prescribed at hospital. FGA and SGA data consumption was obtained from Microstrategy® database. Comparative analysis in relation to the european patterns of prescription and cost analysis were performed. Main outcome measures: percentage of patients with SGA, FGA and long-acting antipsychotics (LAI) and costs per patient.

Results A total of 16.967 patients under treatment with antipsychotics during 2021 were identified: 9.01% FGA and 90.9% SGA. The most frequent FGA were: oral haloperidol (44.4%), oral clotiapine (26.6%) and oral levomepromazine (17.9%). Among the SGA, the most used were: oral quetiapine (37.3%), oral olanzapine (20.2%), oral aripripazole (15.7%) and oral risperidone (11.4%). Regarding the total prescriptions, the percentage of use of LAI was 6.66% (3.43% and 6.98% among FGA and SGA, respectively). The 95.31% total LAI prescriptions were SGA. The use of LAI at hospital was found to be lower than in other European countries (15% according to Arango C. et al 2019). However, the proportion of second generation LAI was higher than the European average (34%). The mean cost per patient was higher for SGA than for FGA (353.5€ vs 27.0€). Likewise, in comparison to conventional injectable antipsychotics, costs per patient were higher for LAI: 155.1€ vs 15.8€ for FGA and 2887.5€ vs 72€ for SGA, respectively.

Conclusion and Relevance In comparison with other European countries, a predominance of the use of second generation LAI has been detected. However, the use of LAI is lower. Cost-effectiveness studies regarding the use of SGA versus FGA and conventional versus LAI antipsychotics are needed in order to optimise the benefits to the patient and minimise the economic burden for the health system.

References

1. Arango C et al. Long-acting injectable antipsychotics for the treatment of schizophrenia in Spain. Rev Psiquiatr Salud Ment (Engl Ed). 2019; 12(2):92–105.

Conflict of Interest No conflict of interest