The effect of early initiation of aripiprazole once-monthly 400 mg on health care resource utilization and health care costs in patients diagnosed with bipolar I disorder: Real-world evidence from US claims data

BACKGROUND: Bipolar I disorder (BP-I) is a chronic and recurrent mental health disorder, broadly characterized by patients who alternate between the extremes of the mood spectrum: mania or hypomania; and depression. In 2015, the total estimated annual cost of BP-I in the United States reached more than 200 billion, approximately 2. 5 times higher than the general population, largely driven by the increased use of acute health care services. Long-acting injectable antipsychotics such as aripiprazole were developed to significantly reduce patient burden for treatment adherence compared with oral formulations, to allow consistent dosing and improved outcomes. Previous real-world evidence studies have shown the benefits of starting aripiprazole once-monthly injection (AOM) at an early stage in patients diagnosed with schizophrenia; however, the effect of early initiation in the BP-I population remains unknown. OBJECTIVE: To evaluate the impact of initiating AOM 400 mg (AOM 400) in adults at an early stage (365 days) in a real-world setting, via a retrospective analysis using claims data from the MarketScan Medicaid database. METHODS: Study outcomes included the numbers of emergency department, hospitalization, outpatient, and pharmacy visits, together with the associated costs over a 1-year time horizon. A generalized linear model was used to compare the annualized costs associated with early, intermediate, and late initiators of treatment, using late initiators as the main reference group. RESULTS: = 0. 01). CONCLUSIONS: This real-world study demonstrates that early initiation of AOM 400 among patients living with BP-I may offer a significant advantage of lower health care resource utilization and associated costs when compared with late initiation.