Health Care Resource Utilization and Costs Associated with Transitioning to 3-month Paliperidone Palmitate Among US Veterans

DerSarkissian, Maral; Lefèbvre, Patrick; Joshi, Kruti; Brown, Brianne; Lafeuille, Marie-Hélène; Bhak, Rachel H.; Hellstern, Michael; Bobbili, Priyanka; Shiner, Brian; Khoury, Antoine C. El; Young‐Xu, Yinong

doi:10.1016/j.clinthera.2018.07.011

Cited by 22 publications

(24 citation statements)

References 33 publications

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“…The present study of the VHA database found that, among patients switching from oral RIS/PALI therapy to PP1M, those with schizophrenia had higher adherence, with lower HRU and no increase in all-cause total costs. The current analysis provides evidence that patients treated with LAI APs experienced improved adherence and significantly lower total medical costs compared with oral AP therapy, which is associated with relatively low levels of treatment adherence, 18 , 19 , 20 high HRU, 21 , 22 and high costs. 12 , 23 The design of the current study allows a direct comparison of how costs changed in the same patients before and after switching from an oral AP to an LAI with a similar mechanism of action.…”

Section: Discussionmentioning

confidence: 88%

Healthcare Resource Utilization and Costs Among Patients With Schizophrenia Switching From Oral Risperidone/Paliperidone to Once-Monthly Paliperidone Palmitate: A Veterans Health Administration Claims Analysis

Patel

Khoury

Huang

et al. 2020

Current Therapeutic Research

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Background Schizophrenia is associated with high health care resource utilization and treatment costs. Objective This study compared treatment patterns, health care resource utilization, and medical costs before and after a switch from oral antipsychotic drug (risperidone or paliperidone [RIS/PALI]) therapy to the long-acting injectable once-monthly paliperidone palmitate (PP1M) in patients with schizophrenia. Methods Data for adult patients (aged ≥18 years) with at least 1 diagnosis of schizophrenia who initiated treatment with oral RIS/PALI ≥6 months before switching and had continuous health plan enrollment during the study period before and after the switch were extracted from the Veterans Health Administration database. Treatment patterns, health care resource utilization, and costs were compared between the period 6 or 12 months before and after switching directly from oral RIS/PALI to PP1M. Results The analysis included 676 and 493 patients in the 6-month and 12-month cohorts, respectively. Adherence to oral RIS/PALI during the 12 months preswitch was 11.0% and 22.1% as measured by proportion of days covered and medication possession ratio ≥80%, respectively. During the 12 months postswitch, adherence to PP1M was 27.0% and 35.9%, respectively. Among patients treated with oral RIS/PALI, from 12 months pre- to 12 months post-PP1M switch, fewer all-cause inpatient stays (2.2 vs 1.1, respectively; P < 0.05) and a shorter mean length of inpatient stay (28.1 and 14.0 days, respectively; P < 0.05) were observed. This pattern was similar for both the number of mental health– and schizophrenia-related inpatient stays and length of stay. Compared with 12 months pre-PP1M switch, significantly higher mean numbers of all-cause outpatient visits and pharmacy visits were observed at 12 months postswitch. In line with health care resource utilization findings, at 12 months pre- versus 12 months post-PP1M switch we observed decreases in all-cause inpatient stay costs ($41,886 vs $20,489; P < 0.05) and increases in outpatient visit costs ($22,005 vs $29,069; P < 0.05). Findings for the 6-month cohort followed a similar pattern. Conclusions Post-PP1M switch, a decrease in total medical costs fully offset an increase in pharmacy costs, resulting in similar total costs. The findings suggest potential economic benefits of switching patients with schizophrenia from oral RIS/PALI to PP1M in the Veterans Health Administration.

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Section: Discussionmentioning

confidence: 88%

Healthcare Resource Utilization and Costs Among Patients With Schizophrenia Switching From Oral Risperidone/Paliperidone to Once-Monthly Paliperidone Palmitate: A Veterans Health Administration Claims Analysis

Patel

Khoury

Huang

et al. 2020

Current Therapeutic Research

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“…These results are consistent with those reported in one study conducted in the United States using electronic health record data; this study assessed the transition from PP1M to PP3M and showed a decrease in the number of inpatient days and outpatient visits, as well as reduced medical costs. 35…”

Section: Discussionmentioning

confidence: 99%

Symptomatic and functional outcomes after treatment with paliperidone palmitate 3-month formulation for 52 weeks in patients with clinically stable schizophrenia

García-Portilla

Llorca²,

Maina

et al. 2020

Therapeutic Advances in Psychopharmacology

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Background: Paliperidone palmitate 3-monthly (PP3M) formulation is a long-acting, injectable antipsychotic treatment approved in many countries worldwide for the maintenance treatment of adult patients with schizophrenia. This single-arm, open-label, phase IIIb study evaluated the efficacy and safety of converting patients with schizophrenia stabilized with paliperidone palmitate 1-month (PP1M) to PP3M in a naturalistic clinical setting. Methods: After screening (days –7 to 1), patients were converted from PP1M (50–150 mg eq.) to PP3M (175–525 mg eq.), and entered a 52-week, flexible-dose PP3M treatment period. The primary efficacy endpoint was symptomatic remission (SR) (Andreasen criteria) at last observation carried forward (LOCF) endpoint. Results: Patients ( n = 305) received PP3M, of whom 291 (95.4%) completed the study. Doses of PP3M remained stable during the 12-month treatment period, and changes in dose were uncommon. Overall, 56.8% of patients [95% confidence interval (CI): 51.0, 62.4] achieved SR, and 31.8% achieved both symptomatic and functional remission (Personal and Social Performance scale total score > 70) at LOCF endpoint. Secondary endpoint results were generally consistent with primary endpoint results. There were improvements in Positive and Negative Syndrome Scale total, subscale and Marder factor scores, and also Clinical Global Impression-Severity and -Change scores from baseline to LOCF endpoint. Carer burden was reduced, and the proportion of patients requiring hospitalization for psychiatric reasons decreased from 13.5% in the 12 months prior to baseline to 4.6% during the treatment period. No new safety signals were identified. Conclusion: Results from this naturalistic study were similar to those observed in previous randomized clinical trials of PP3M and underline the importance of continuous maintenance treatment in patients with schizophrenia.

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“…In 2015, the FDA approved once-every-3month paliperidone palmitate (PP3M). The advent of this new reduced dosing frequency therapy has been found to increase treatment adherence, and patients were shown to be more persistent on PP3M treatment [16,17]. The administration of PP3M requires fewer clinical visits and thereby lower hospitalization rates and ultimately reduced healthcare resource utilization (HRU) and healthcare costs [16,17].…”

Section: Introductionmentioning

confidence: 99%

“…The advent of this new reduced dosing frequency therapy has been found to increase treatment adherence, and patients were shown to be more persistent on PP3M treatment [16,17]. The administration of PP3M requires fewer clinical visits and thereby lower hospitalization rates and ultimately reduced healthcare resource utilization (HRU) and healthcare costs [16,17]. In a post hoc analysis comparing median time to relapse across three different treatment trials, Weiden et al discovered that after PP3M discontinuation, the time to relapse was much longer compared with PP1M [18].…”

Section: Introductionmentioning

confidence: 99%

Health Outcomes Among Patients Diagnosed with Schizophrenia in the US Veterans Health Administration Population Who Transitioned from Once-Monthly to Once-Every-3-Month Paliperidone Palmitate: An Observational Retrospective Analysis

et al. 2019

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Introduction: There is limited literature on treatment patterns, healthcare resource utilization (HRU), and costs among patients who transition from once-monthly paliperidone palmitate (PP1M) to once-every-3-month paliperidone palmitate (PP3M) in a real-world setting. Hence, this study compared treatment patterns, HRU, and costs 12-month pre-and post-PP3M transition among Veteran's Health Administration (VHA) patients with schizophrenia. Methods: Patients with schizophrenia (aged C 18 years) who initiated PP1M and transitioned per on-label criteria to PP3M (no treatment gap of [ 45 days in PP1M during the 4 months prior, same dose strength of the last two PP1M claims, and appropriate dose conversion from last PP1M to first PP3M claim) from January 2015 to March 2017 were included from the VHA database. The first transition date to PP3M was identified as the index date. Patients were required to have 12-month pre-and post-PP3M continuous health plan eligibility. Outcomes were compared using the Wilcoxon-signed rank and McNemar's test, appropriately. Results: The study included 122 patients [mean (SD) age: 54 (13.7) years]. Pre-and post-PP3M transition, 64.8% and 61.5% of patients were adherent (proportion of days covered C 80%) to PP1M and PP3M, respectively. Comparison of HRU outcomes pre-and post-PP3M transition exhibited lower all-cause outpatient (37.5 vs. 31.1, p \ 0.0001) and pharmacy visits (56.1 vs. 46.7, p \ 0.0001). Similar trends were seen for mental health and schizophrenia-related outpatient and pharmacy HRU. Comparison of cost outcomes resulted in lower all-cause outpatient

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Health Care Resource Utilization and Costs Associated with Transitioning to 3-month Paliperidone Palmitate Among US Veterans

Cited by 22 publications

References 33 publications

Healthcare Resource Utilization and Costs Among Patients With Schizophrenia Switching From Oral Risperidone/Paliperidone to Once-Monthly Paliperidone Palmitate: A Veterans Health Administration Claims Analysis

Healthcare Resource Utilization and Costs Among Patients With Schizophrenia Switching From Oral Risperidone/Paliperidone to Once-Monthly Paliperidone Palmitate: A Veterans Health Administration Claims Analysis

Symptomatic and functional outcomes after treatment with paliperidone palmitate 3-month formulation for 52 weeks in patients with clinically stable schizophrenia

Health Outcomes Among Patients Diagnosed with Schizophrenia in the US Veterans Health Administration Population Who Transitioned from Once-Monthly to Once-Every-3-Month Paliperidone Palmitate: An Observational Retrospective Analysis

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