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T120

SCHIZOPHRENIA-RELATED HOSPITALIZATION HISTORY BEFORE LONG-ACTING INJECTABLE ANTIPSYCHOTIC INITIATION AND ITS ASSOCIATION WITH SUBSEQUENT ADHERENCE AND HOSPITALIZATIONS AMONG DUAL-ELIGIBLES: THE CRITICAL PERIOD STUDY

Pengxiang Li — Zhi Geng1, Brahim Bookhart2, Carmela Benson3, Jalpa Doshi4 1Division of General Internal Medicine, University of Pennsylvania, 2Janssen Scientific Affairs, LLC, 3Medical Affairs Neuroscience, Johnson and Johnson Innovative Medicine, 4Division of General Internal Medicine, University of Pennsylvania; Leonard Davis Institute of Health Economics

2026 ASCP Annual Meeting

Background

Real-world evidence has demonstrated that long-acting injectable antipsychotic (LAI) use is associated with improved medication adherence and a reduced risk of schizophrenia (SCZ)-related hospitalizations. It is theorized that the timing of first LAI use may play a critical role in influencing patient outcomes. The CRITICAL PERIOD study examined the SCZ-related hospitalization history prior to initiating an LAI and its association with antipsychotic (AP) adherence and healthcare resource use in dual-eligible Medicare beneficiaries with SCZ in the United States.

Method

Using 2006-2021 national Medicare and Medicaid claims we identified dualeligible beneficiaries with a diagnosis of SCZ who initiated an LAI between 7/1/2009 and 12/31/2021 (first observed LAI fill date = index date). Patients were required to have continuous Medicaid or Medicare fee-for service Part D coverage from their first observed SCZ diagnosis date until the index date (pre-index period), and 12-months continuous postindex coverage. Patients were stratified by the number of SCZ-related hospitalizations in the pre-index period (0, 1, 2-5, or ≥6 hospitalizations). Outcomes included adherence to any LAI and all-cause, mental health related, and SCZ-related hospitalizations during the 12-month post-index period. Logistic regressions were used to assess how the number of SCZ-related hospitalizations during the pre-index period was associated with outcomes, while controlling for demographic and clinical characteristics. Sensitivity analyses were conducted among patients ≤35 years and ≤25 years on index date. Result: The final sample consisted of 9,472 patients initiating an LAI; patients had a median age of 29 years and were primarily male (70%) and non-White (59%). Over half (54%) of patients had 0 SCZ-related hospitalizations in the pre-index period; the remaining patients had 1 (21%), 2 to 5 (20%), and ≥6 (4%) SCZ-related hospitalizations, respectively. The median time from first observed SCZ diagnosis to first observed LAI initiation was 9 months (5 for 0, 12 for 1, 24 for 2 to 5, and 45 for ≥6 SCZ-related hospitalizations). In descriptive analyses, an increasing number of SCZ-related hospitalizations in the pre-index period was associated with lower rates of adherence to any LAI (41% to 23%) and higher rates of any all-cause (26% to 72%), mental health related (22% to 71%), and SCZ-related hospitalization (18% to 66%) during the 12-month post-index period. Logistic regressions confirmed these results: for instance, compared to patients with 0 SCZ-related hospitalizations, those with 2 to 5 SCZ-related hospitalizations in the pre-index period had lower odds of adherence to any LAI (OR: 0.81, p LESS THAN 0.01) and higher odds of any all-cause (OR: 1.91, p LESS THAN 0.01), mental health related (OR: 2.10, p LESS THAN 0.01), and SCZ-related hospitalization (OR: 2.36, p LESS THAN 0.01) in the post-index period. Sensitivity analyses among patients ≤35 years and ≤25 years on index date showed similar findings.

Discussion

This study found that dual-eligible Medicare beneficiaries who had one or more SCZ-related hospitalizations before starting an LAI had lower odds of maintaining adherence and higher risk of subsequent hospitalizations. These findings underscore the importance of timely LAI initiation, as waiting until patients experience one or more SCZ-related hospitalizations may miss a critical window when earlier use could improve adherence, stabilize symptoms, and reduce healthcare utilization.