These conclusions strengthen the belief that injections are more beneficial for individuals with schizophrenia than oral medications, said Rutgers University psychiatric clinical pharmacist Daniel Greer, the lead author of the study.
“One of the biggest problems with patients who have schizophrenia or schizoaffective disorder, is a lot of the symptoms can cause impairment in functioning, and mental functioning,” he said. “So remembering to take medication every day when you’re having hallucinations or delusions or disorganized thinking can be quite hard.”
Although oral antipsychotics are more readily available for schizophrenia patients at hospital discharge, injections benefit by slowly releasing the treatment over time, said Greer.
“Some of them are relatively quick acting. For example, one of them is every two weeks, you get the shot. But the majority that we use are every month or every two months,” Greer said. “There’s also formulations that’s once every three months, and there’s one that’s once every six months. So this is a lot easier for the patients because they don’t have to remember to do something every day, and it keeps that drug level in their system really stable.”
But Greer, who also practices at Saint Joseph’s University Medical Center in Paterson, New Jersey, said there are significant financial obstacles.
“Long-acting injectable medications can be more expensive than the oral medications,” he said.
Historically, some health insurers have favored oral treatments because antipsychotic injections cost more to cover. But antipsychotics end up causing higher medical costs in the long run, and hospitals are subject to penalties for high readmission rates over time.
“Hospitals get less reimbursement for patients who are readmitted within 30 days,” Greer said. “So there are financial implications if you’re having a lot of quick readmissions for the same reason that you just discharge patients on.”