Long-acting injectable antipsychotics for schizophrenia treatment: optimal duration from a cost-effectiveness standpoint

Abstract

One of the most significant challenges in schizophrenia treatment is medication non-adherence, which occurs in 50-70% of patients. Non-adherence leads to relapse, hospitalizations, and increased costs. Long-acting injectable antipsychotics (LAI-APs) are an important option for preventing relapses by improving adherence, particularly in patients with impaired insight. Meta-analyses and real-world evidence demonstrate that LAI-APs are generally superior to oral antipsychotics in reducing hospitalizations.
The higher cost of LAI-APs compared to oral formulations raises discussions about cost-effectiveness. However, research indicates that LAI-APs increase treatment adherence, thereby reducing hospitalizations and emergency department visits. Consequently, by approximately the end of the first year, the difference in medication costs is offset within total healthcare expenditures. Cost-effectiveness varies according to countries' health policies and service costs.
A calculation based on January 2026 data from the Turkish pharmaceutical market reveals significant price differences between typical and atypical LAI-APs. The annual cost of typical LAI-APs is below EUR218, while atypical LAI-APs exceed EUR780. Switching from an atypical LAI-AP to its oral form reduces costs by 3.5 to 10-fold, whereas this reduction ranges from 2 to 7-fold for typical agents. The cost of typical LAI-APs is significantly lower than that of atypical agents.
The optimal duration of LAI-AP use should be individualized based on patient characteristics. During the first 1-2 years following the acute phase and stabilization, LAI-APs should be considered as a "bridge treatment" to enhance insight and strengthen the therapeutic alliance. Transitioning to oral therapy should be evaluated in patients who have achieved clinical remission, developed insight, and remained stable for several years. When selecting an LAI-AP, given the high cost of atypical agents, well-tolerated typical LAI-APs should be prioritized. It must be remembered that treatment success depends not only on the route of medication administration but also on a strong therapeutic alliance and psychosocial support.