Comparative effectiveness of injectable paliperidone palmitate versus oral atypical antipsychotics: early postmarketing evidence

Morrato, Elaine H.; Parks, Joe; Campagna, Elizabeth J.; Muser, Erik; Thomas, Deborah S.K.; Fang, Hai; Doshi, Dilesh

doi:10.2217/cer.14.50

Cited by 12 publications

(13 citation statements)

References 24 publications

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“…The findings of the current study are consistent with those of previous studies [12][13][14][15]. Baser et al found that VA patients with schizophrenia and treated with PP had lower inpatient costs, higher pharmacy costs and nondifferent total healthcare costs, as well as lower inpatient admission rates, compared with a matched cohort of OAA patients [12].…”

Section: Summary On Study Cyclessupporting

confidence: 91%

“…Lafeuille et al showed that PP versus OAAs treatment was associated with lower all-cause re-hospitalization or ER visits rates and lower institution costs in the hospital settings [13]. An observational comparative effective-ness study among Medicaid patients from the state of Missouri showed that patients starting with PP versus OAAs had a lower ER visit rate and a lower hospitalization rate [14]. The PRIDE randomized open-label multicenter study of adult patients with schizophrenia showed that compared with OAAs, PP was associated with lower hazard of treatment failure (increased psychiatric services was one of the components used to assess treatment failure) rates [15].…”

Section: Summary On Study Cyclesmentioning

confidence: 99%

“…Paliperidone palmitate (Invega Sustenna ® , Janssen Pharmaceuticals, Inc, NJ, USA; PP) is an US FDAapproved atypical LAT indicated for acute and maintenance treatment of schizophrenia in adults [9]. There are few studies examining the association of PP versus OAAs on the healthcare resource utilization or costs in the real world to date [12][13][14][15]. With its extremely low water solubility, PP is gradually released into the systemic circulation after intramuscular injection allowing for an extended dosing interval.…”

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confidence: 99%

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Impact of paliperidone palmitate versus oral atypical antipsychotics on healthcare outcomes in schizophrenia patients

et al. 2015

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Section: Summary On Study Cyclessupporting

confidence: 91%

Section: Summary On Study Cyclesmentioning

confidence: 99%

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Impact of paliperidone palmitate versus oral atypical antipsychotics on healthcare outcomes in schizophrenia patients

et al. 2015

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“…In a matched cohort of Veterans Affairs (VA) patients with schizophrenia, Baser et al found that treatment with PP1M was associated with lower inpatient costs, higher pharmacy costs, and non-different total healthcare costs, as well as lower inpatient admission rates [25]. Morrato et al, in an observational comparative effectiveness study among Medicaid patients from the state of Missouri, showed that patients starting treatment with PP1M versus OAAs were less likely to have ER visits and hospitalizations although the difference in hospitalizations did not achieve statistical significance [26]. A retrospective cohort study using hospital discharge and billing records also showed that PP1M versus OAA treatment in an inpatient setting was associated with lower risks of all-cause re-hospitalization and ER use and lower institution costs [11].…”

Section: Discussionmentioning

confidence: 99%

Adherence, healthcare resource utilization and Medicaid spending associated with once-monthly paliperidone palmitate versus oral atypical antipsychotic treatment among adults recently diagnosed with schizophrenia

et al. 2017

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BackgroundOnce-monthly paliperidone palmitate (PP1M) is a long-acting injectable antipsychotic that may increase adherence rates, reduce hospitalizations, and lower medical costs compared to oral atypical antipsychotics (OAAs) among schizophrenia patients. However, the impact of PP1M in recently diagnosed patients remains unknown. The present study compared adherence, healthcare resource utilization and Medicaid spending between schizophrenia patients initiating PP1M versus OAA, among patients recently diagnosed (defined using ages 18–25 years as a proxy) and among the overall population.MethodsMedicaid data from five states (09/2008–03/2015) were used to identify adults with schizophrenia initiated on PP1M or OAAs (index date) on or after 09/2009. Outcomes were compared between PP1M and OAA groups following inverse probability of treatment weighting (IPTW). Univariate linear and Poisson regression models with nonparametric bootstrap procedures were used to compare the 12-month healthcare resource utilization and costs using rate ratios (RRs) and mean monthly cost differences (MMCDs), respectively.ResultsOverall, patients initiated on PP1M (N = 2053) were younger (mean age: 41 vs. 44 years) and had more baseline antipsychotic use (88% vs. 62%) compared to OAA patients (N = 22,247). IPTW resulted in balanced baseline characteristics. Among recently diagnosed patients, PP1M was associated with better adherence (PDC ≥ 80%: 29% vs. 21%, P < 0.001) on the index medication as well as less use of other psychiatric medications, compared to OAAs. Adherence findings were similar for the overall cohort. Among recently diagnosed patients, lower medical costs associated with PP1M (MMCD = $-466; P = 0.028) outweighed the higher pharmacy costs (MMCD = $322; P < 0.001) resulting in similar total healthcare costs across groups (MMCD = $-144; P = 0.553). Overall, findings were similar but there was a trend toward a lower magnitude of medical cost savings (MMCD = $-286; P < 0.001). Reductions in medical costs were mainly driven by reductions in inpatient days (recently diagnosed RR = 0.85, P = 0.353; overall RR = 0.84, P = 0.004) and in home care visits (recently diagnosed RR = 0.43, P = 0.008; overall RR = 0.78, P = 0.048).ConclusionsPP1M patients demonstrated significantly lower medical costs offsetting higher pharmacy costs relative to OAA patients. Recently diagnosed patients using PP1M may have greater medical cost savings relative to OAAs than that observed in the overall population, highlighting the potential economic impact of PP1M in adults recently diagnosed with schizophrenia.

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“…The clinical management of schizophrenia has long been recognized as challenging due to patients' propensity for non-adherence to the daily dosing required for efficacy of oral atypical antipsychotic (OAT) medications. Previous studies have reported that poor adherence to and low persistence with oral medications increases the relapse rate, number of hospitalizations, and associated healthcare costs in schizophrenia patients [2][3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Effects of Paliperidone Palmitate on Healthcare Utilization and Costs for Patients with Schizophrenia: A Claim-based Mirror-image Study in South Korea

Lee¹,

Lee

Choi

et al. 2020

Clin Psychopharmacol Neurosci

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Objective: Long-acting injectable (LAI) antipsychotics, such as paliperidone palmitate (PP), are known to improve treatment adherence in patients with schizophrenia, which can lead to reductions in relapse and hospitalization rates. However, relatively few studies have demonstrated the economic impact of LAIs, especially in Asian populations. Methods: We conducted a claim-based mirror-image study to explore changes in healthcare utilization and associated costs, among 1,272 South Korean patients with schizophrenia (ICD-10-CM code F20), between the 1-year periods before and after the initiation of PP treatment. Results: Patients accessed outpatient services more frequently after versus before starting PP treatment, with the number of prescription days increasing by 133.45 (p ＜ 0.0001) and the associated costs increasing by USD 1,497.15 (p ＜ 0.0001). The number of admission days was reduced by 11.33 after starting PP treatment (p ＜ 0.0001) and the associated costs were reduced by USD 1,220.75 (p ＜ 0.0001). However, admission cost savings were different according to patients' oral drug compliance. The daily dosages for benztropine, procyclidine, and propranolol decreased, showing that there were fewer side-effects after PP-treatment (p ＜ 0.0001). Conclusion: Although the high acquisition cost of PP has been regarded as an obstacle to its clinical use, our results imply that the high prescription costs for PP may be counterbalanced by the reduced admission costs associated with its use. Economic outcomes for patients treated with LAIs should be investigated further to help healthcare decision-makers and providers to determine the value of LAIs relative to other treatment medications.

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Comparative effectiveness of injectable paliperidone palmitate versus oral atypical antipsychotics: early postmarketing evidence

Abstract: Early evidence for paliperidone palmitate under real-world conditions is encouraging. However, caution should be taken until additional research substantiates the findings with greater certainty.

Cited by 12 publications

References 24 publications

Impact of paliperidone palmitate versus oral atypical antipsychotics on healthcare outcomes in schizophrenia patients

Impact of paliperidone palmitate versus oral atypical antipsychotics on healthcare outcomes in schizophrenia patients

Adherence, healthcare resource utilization and Medicaid spending associated with once-monthly paliperidone palmitate versus oral atypical antipsychotic treatment among adults recently diagnosed with schizophrenia

Effects of Paliperidone Palmitate on Healthcare Utilization and Costs for Patients with Schizophrenia: A Claim-based Mirror-image Study in South Korea

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