Transitioning from oral risperidone or paliperidone to once-monthly paliperidone palmitate: a real-world analysis among Veterans Health Administration patients with schizophrenia who have had at least one prior hospitalization

Abstract

Objective: To address gaps in the literature on healthcare resource utilization (HRU) and costs among patients with schizophrenia and prior hospitalization who transition from oral risperidone or paliperidone (oral ris/pali) to once-monthly paliperidone palmitate (PP1M) in a real-world setting by comparing treatment patterns, HRU, and costs 12-months pre-and post-transition to PP1M among Veterans Health Administration (VHA) patients affected by schizophrenia who have had !1 hospitalization. Methods: VHA patients with schizophrenia (aged !18 years) who initiated oral ris/pali, had !1 allcause inpatient stay, and transitioned to PP1M from January 2015-March 2017 were included from the VHA database. The first transition date to PP1M was identified as the index date. Patients were required to have continuous health plan eligibility for 12 months pre-and post-PP1M. Outcomes were compared using the Wilcoxon signed-rank and McNemar's test, as appropriate. Results: The study included 319 patients (mean [SD] age ¼ 51.6 [4.2] years) during 12 months of baseline and follow-up. During pre-PP1M transition, 7.2% of the patients were adherent (proportion of days covered [PDC] ! 80%) to oral ris/pali. Post-PP1M transition, 27.6% of the patients were adherent to PP1M. Comparison of HRU outcomes from the pre-to post-PP1M transition revealed significantly lower all-cause inpatient stays (3.5 vs 1.4, p < .0001) and shorter inpatient length of stay (43.4 vs 18.3 days, p < .0001). Similar trends were seen for mental health and schizophrenia-related HRU. Cost outcome comparison indicated significantly lower all-cause inpatient costs

Paliperidone Palmitate: A Breakthrough Treatment for Schizophrenia? A Review on Patient Adherence Levels, Healthcare Resource Utilization and Costs

“…Ten studies were selected: nine retrospective cohort studies [28][29][30][31][32][33][34][35][36] and one mirror study. 37 Among these papers, two studies showed data on adherence patterns only 29,34 and eight studies presented data on adherence levels and other clinical outcomes. 28,[30][31][32][33][35][36][37] Moreover, compliance patterns have been studied in subjects receiving exclusively PP1M in eight papers, [28][29][30]33,34,36,37 while two studies reported data on a population treated with different LAI, including PP1M.…”

“…37 Among these papers, two studies showed data on adherence patterns only 29,34 and eight studies presented data on adherence levels and other clinical outcomes. 28,[30][31][32][33][35][36][37] Moreover, compliance patterns have been studied in subjects receiving exclusively PP1M in eight papers, [28][29][30]33,34,36,37 while two studies reported data on a population treated with different LAI, including PP1M. 32,35 Finally, in all the studies, patients were treated with PP1M; no data on PP3M and PP6M were found (Table 1).…”

“…The only mirror study evaluated in this narrative review reports data on patients with schizophrenia pre and post PP1M initiation. 37 Using the Veterans Health Administration database, the Authors studied treatment patterns among subjects who switched from a previous treatment with oral risperidone/paliperidone to PP1M (January 2014 -March 2018). Adherence levels of the 12-months pre and post transition to PP1M (319 individuals) and 6-months pre and post transition to PP1M (401 individuals) were reported.…”

Comparison of clinical outcomes in patients with schizophrenia following different long-acting injectable event-driven initiation strategies

“…An important challenge in schizophrenia care is adherence to therapy, which is crucial for reducing the risk of schizophrenia relapse and its negative consequences such as hospitalization and self-harm [8][9][10][11][12] . Studies have demonstrated that long-acting injectable antipsychotics (LAIs), which require less frequent administration than oral antipsychotics (OAPs), are associated with better adherence than OAPs [13][14][15][16] . Some studies have also found that treatment with LAIs was associated with significant reductions in healthcare resource utilization, with the magnitude of results varying depending on the study design and patient population 17,18 .…”

Transitioning from Once-Monthly to Once-Every-3-Months Paliperidone Palmitate Among Veterans with Schizophrenia

“…Subsequent studies have shown that PP1M has improved adherence, lower inpatient and long-term health care resource utilization (HRU), and lower medical costs compared with oral therapies for patients with schizophrenia. 18 , 21 , 22 In 2015, the FDA approved once-every-3-months paliperidone palmitate (PP3M) for the treatment of adults with schizophrenia. With reduced dosing frequency, PP3M treatment adherence was improved and caregiver burden was lessened.…”