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

Objectives: Real world evidence has shown the benefits of initiating aripiprazole once-monthly 400 mg (AOM 400) early in patients living with schizophrenia; however, the impact on patients living with bipolar-I disorder (BP-I) remains unknown. This study examined the impact of early initiation of AOM 400 on hospitalization risk, healthcare resource utilization (HCRU), and associated costs in patients diagnosed with BP-I.
Methods: This retrospective cohort study was conducted using the Merative™ MarketScan® Medicaid claims data (01/01/2014 to 12/31/2022). Adult patients diagnosed with BP-I who initiated AOM 400 were categorized based on the time to initiation after diagnosis as: ≤180 days (early initiators), >180–365 days (intermediate initiators) and >365 days (late initiators). The primary outcomes were HCRU and adjusted cost 1 year post AOM 400 initiation. Multivariable negative binomial regression was used for HCRU and generalized linear model with gamma distribution was used for costs.
Results: Among 866 patients diagnosed with BP-I (median age 36 years), early initiators of AOM 400 had significantly lower risks of emergency room visits (IRR=0.76, 95% CI: 0.61–0.94) and outpatient pharmacy visits (IRR= 0.82, 95%CI, 0.73 - 0.93). Early initiators also incurred lower pharmacy costs ($18,786 vs. $23,503, p = 0.03) and reduced medical costs ($13,897 vs. $18,277, p=0.01). Overall, annualized total costs were lower for early initiators compared to late initiators, $31,085 vs $40,599, p = 0.0007.
Conclusion: Early initiation of AOM 400 among patients living with BP-I can offer a significant advantage with respect to their healthcare resource utilization and costs.