A Reduction in Hospital Bed Day Usage Associated with Risperidone Long Acting Injection (RLAI) M TAYLOR* , A CURRIE**, K LLOYD***, C JARROLD *SPRINGPARK CENTRE, GLASGOW G22 5EU,**THE HADRIAN CLINIC, NEWCASTLE NE4 6BH, *** UNIVERSITY OF WALES, SWANSEA UK SA2 8PP INTRODUCTION RLAI is a long acting atypical antipsychotic offering at least equivalent efficacy to the oral formulation of risperidone. 1 The long acting formulation has the advantage of improved compliance compared with oral atypicals 2 and an improved side effect profile compared with long acting agents. 3 More data is needed to understand the impact of RLAI on secondary care resources. HYPOTHESIS • The use of RLAI is associated with diminished relapse, using inpatient bed usage as a proxy endpoint. Secondary Aim • To describe the real world population being prescribed RLAI and the reasons behind drug choice METHODS • Twenty four months of retrospective data were collected for 100 patients with a previous diagnosis of schizophrenia or schizoaffective disorder who had received RLAI. Data were collected for 12 months prior to commencement of RLAI and 12 months post commencement of RLAI. • Data were collected at 4 centres across the UK using a standardised data collection form. • Assessors were blind to the hypothesis and overall results. • The outcome measures used were inpatient bed day use, secondary care visits and self harm episodes. DISCUSSION • The consequences of relapse in schizophrenia are potentially devastating. The cumulative five year relapse rate has been reported to be 82% with discontinuation of antipsychotic medication increasing risk of relapse by nearly five times. 4 • Initiating patients on RLAI led to a 12.9% decrease in the number of bed days in the 12 months post initiation compared to the 12 months pre initiation, indicating a diminished rate of relapse in the patients studied. • Increases in other secondary care contact were unrelated to changes in disease state ( 2 patients had to attend clinic for administration of their depot injections and others related to housing issues and unrelated addiction problems). • The population studied were chronically unwell with an average time since onset of symptoms of over 10 years. This, combined with the high number of patients being switched due to previous poor compliance or side effects, means the gains made by the use of RLAI in this population would be expected to be less dramatic than in people treated earlier in the disease trajectory. CONCLUSION • The use of RLAI led to a substantial reduction in hospital bed usage which equated to a saving of £1106 per patient for one year. 5 • The decrease in bed days did not lead to excessive increases in consultant outpatient visits, while the number of CPN visits decreased. • In this study RLAI was used in patients who were chronically unwell and who had poor compliance or side effects with existing treatments. RESULTS Demographics Treatment Immediately Prior to Initiating RLAI Number of patients 100 Age Mean 40.7 yrs Range 19-70 yrs Sex 61% Male 39% Female Average time between onset of symptoms and beginning RLAI 10.9 years Reason for starting RLAI Reason Stated for Starting Risperdal Consta Percentage of patients Poor compliance 33 Lack of efficacy 21 Patient preference 1 Side effects 29 Tardive dyskinesia 0 Patient preference and side effects 1 Poor compliance and side effects 5 Poor compliance and lack of efficacy 3 Lack of efficacy and side effects 7 Secondary Care Resource Utilisation Pre and Post Commencement of RLAI Hospital Consultant CPN Other secondary Bed Days Outpatient Visits Visits care contact 12 months pre Risperdal Consta 4951 284 2032 62 12 months post Risperdal Consta 4308 289 1932 100 Self Harm Pre commencement of RLAI Post commencement of RLAI No of self harm episodes 5 1 Previous antipsychotic Percentage of treatment patients Typical Depot 35 Atypical Oral 58 Typical Oral 7 REFERENCES 1. Chue P et al. Comparative efficacy and safety of long acting risperidone and risperidone oral tablets. Schizophrenia Res 2002; 53(suppl 3) S174-5 2. Kane JM Strategies for improving compliance in treatment of schizophrenia by using a long-acting formulation of an antipsychotic: clinical studies. J Clin Psychiatry. 2003;64 Suppl 16:34-40. 3. Hoeskstra R Improved efficacy and tolerability following direct switch from conventional depot neuroleptics to risperidone long acting injection CINP 2004 PO1.418 4. Robinson J et al Predictors of relapse following response from a first episode of schizophrenia or schizoaffective disorder Arch Gen Psychiatry. 1999 Mar;56(3):241-7. 5. Netten and Curtis Unit Costs of Health and Social Care 2004 Personal Social Services Research Unit, University of Kent, 2004 ACKNOWLEDGMENT All data collection was carried out by staff in the audit centres. The investigators would like to thank Janssen-Cilag for their sponsorship of this audit and pH Associates for their support in preparing this poster.