OBJECTIVES: To review the available Real World Data (RWD) demonstrating comparative advantages of newer LAIs over oral antipsychotics (OAPs) in Schizophrenia with respect to relapse, hospitalization, and economic outcomes.

METHODS: A systematic review of literature (2000- present) was done by two reviewers searching Embase, PubMed/Medline, EBSCO, PsycINFO, ScienceDirect, and Cochrane Library databases. Search terms and screening criteria for article selection included LAI cost-effectiveness, oral antipsychotics, hospitalization/rehospitalization, relapse, economic benefits, and newer LAIs. Selected articles were classified according to the type of RWD sources used and factors such as relapse frequency, LOS, SCZ-related & all-cause hospitalization, and economic/humanistic outcomes measured.

RESULTS: A total of 62 articles met the study selection criteria, targeting three key RWD measures: relapse, hospitalization, and economic outcomes. Studies (n=11) suggest when newer generation LAIs are utilized after the first-episode, relapse rates decrease significantly and SCZ-related hospitalizations drop. The reported relapse range in reviewed studies varied between 16%-93%, depending on the follow-up period (typically 1-2 years). Reduction in hospitalization with LAIs and relapse risk were primarily assessed in most studies (n=11) via Odds Ratios (OR, a range of 19-53%) and Relative Risk (RR) ratios, with a range that varied widely. Many pre-post (n=19) and modeling studies showed that a switch to one-month paliperidone-palmitate (PP1M) in most cases delivered lower overall treatment costs (short-&long term), stronger net savings (relative to pharmacy & outpatient costs), lower mean inpatient costs, plan-level, and per-patient costs.

CONCLUSIONS: Superiority of LAIs over OAPs is evident in terms of their potential to lower relapse frequencies, ER visits, psychiatric hospitalization, and LOS. However, RWE shows comparative cost advantages of LAIs relative to one another (newer versus older), and older OAPs is mostly limited. It is also unclear whether economic benefits and lower hospitalization can outweigh higher LAI prices.