THE TREATMENT OF SCHIZOPHRENIA AND SCHIZOAFFECTIVE DISORDERS: ANALYSIS OF REAL WORLD EVIDENCE

Background and Objectives
For the treatment of schizophrenia (F20) and schizoaffective disorders (F25) the long-acting antipsychotics of first (1G-LAI) and second generation (2G-LAI) in depot injectable forms are available. The advantages of 2G-LAI lie in less frequent use, stable plasma concentrations and manageable side effects, thus being the preferred treatment in non-adherent patients. The aim of the study was to analyze the real-world data and to determine whether 2G-LAI prescriptions in the Czech Republic are exploited to their full potential.

Methods
The patient level data on prescriptions and hospitalizations connected with F20/F25 diagnosis was collected from General Health Insurance Company of the Czech Republic, which represents approximately 60 % of patients in the Czech Republic. The data were processed by SQL and extrapolated to all Czech population.

Results
Approximately 50 thousand patients have schizophrenia and schizoaffective disorders in the Czech Republic every year, with the increase of patients of around 14 % over the observed period of 7 years. Costs decreased by around 15 %. The most widely used are oral antipsychotics (80 %), followed by 1G-LAI with 16 % share and 2G-LAI with 4 % share of patient-treatment. In case of non-adherence, which is estimated to occur in 40-50 % of patients, the health-care providers (HCP) should consider 2G-LAI. However, only around 10 % of HCP ever prescribed 2G-LAI and 80 % of 2G-LAI were prescribed by 35 % of them.

Conclusion
The 2G-LAI represent highly convenient and safe, if more expensive treatment, but it seems the budget could accommodate them. The difference between HCP embracing modern treatment approaches by prescribing 2G-LAI and HCP who are reluctant to prescribe a single prescription of 2G-LAI is stark. Despite their advantages, 2G-LAI remain an underutilised option in the Czech Republic.