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

Abstract

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.

The Impact of Once-Monthly Paliperidone Palmitate on Healthcare Utilization Among Patients With Schizophrenia Treated in an Integrated Healthcare System: A Retrospective Mirror-Image Study

“…In addition to reduction in schizophrenia-related psychotic events requiring an ER visit and/or hospitalization, better control of schizophrenia symptoms also likely positively impacts self-management behaviors with regard to physical and mental comorbidities common in these patients, thereby leading to improvement in overall physical and mental health and, in turn, reduction in mental health-related and all-cause acute healthcare use [ 39 ]. Our findings are consistent with previous similar studies on this topic [ 29 – 31 ]. For example, in a previous study of Veteran Affairs patients transitioning from orally administered paliperidone/risperidone to PP1M, Patel et al found that the mean number of visits reduced for all-cause (2.3 to 1.5, p < 0.05), mental health-related (1.5 to 0.8, p < 0.05), and schizophrenia-related inpatient visits (0.6 to 0.3, p < 0.05) from 12 months before to 12 months after transitioning to PP1M.…”

“…The increase in the frequency of outpatient visits along with PP1M administration costs adds to the routine schizophrenia treatment costs in patients with PP1M. However, it has been reported that the increase in routine schizophrenia treatment costs in patients on PP1M is offset by the reduction in total costs due to reduced acute care utilization [ 23 , 29 , 31 ]. Taken together, our findings combined with those from other similar studies indicate that clinical and economic benefits are associated with PP1M.…”

“…Once-monthly paliperidone palmitate (PP1M), a long-acting injectable dosage form of paliperidone, was approved by the US Food Drug Administration in September 2009 for emergent and maintenance treatment of schizophrenia. Prior studies have shown that use of PP1M was associated with increased medication adherence and reduced inpatient visits, 30-day readmissions, length of stay, and ER visits [ 23 – 31 ]. These studies have involved patients with certain types of insurance such as Medicaid and Medicare Advantage or specific patient populations such as Veteran Affairs patients.…”

Real-World Outcomes and Costs Following 6 Months of Treatment with the Long-Acting Injectable (LAI) Aripiprazole Lauroxil for the Treatment of Schizophrenia

“…Adherence to therapy with AL in the current study was similar to or exceeded adherence reported after a switch from oral antipsychotics to once-monthly paliperidone palmitate in two published studies that used the 6-month pre/post design [24,25]. Other studies on adherence with LAI antipsychotics for the treatment of schizophrenia have assessed longer follow-up periods.…”

“…These findings are supported by results of other real-world studies that assessed healthcare costs associated with initiating once-monthly paliperidone palmitate. It was reported that post paliperidone palmitate switch, a decrease in inpatient costs was offset by an increase in pharmacy costs, resulting in similar total costs compared to pre-switch [24,25]. A study examining costs 6 months before versus after a switch from an oral medication to once-monthly aripiprazole monohydrate similarly reported increased pharmacy costs and reduced hospital costs [28].…”