Health care resource utilization and costs of California Medicaid patients with schizophrenia treated with paliperidone palmitate once monthly or atypical oral antipsychotic treatment

Pesa, Jacqueline; Doshi, Dilesh; Wang, Li; Yüce, Hüseyin; Başer, Onur

doi:10.1080/03007995.2016.1278202

Cited by 27 publications

(55 citation statements)

References 35 publications

(51 reference statements)

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“…In alignment with our results, Shah et al 17 also noted that patients prescribed LAIs had higher schizophrenia-related outpatient visits and more prescription fills, which can be explained by the frequent provider visits for LAI administration. Similar findings were discovered in other studies such as reduced risk of hospitalization and fewer inpatient days when comparing patients on PP1M vs OAAs [32][33][34] . The reduction in inpatient stays and LOS for PP1M patients is further supported by findings from a study by Lafeuille et al 9 , which found that, upon transitioning to PP1M from OAA, patients benefitted from a 36% relative risk reduction of hospitalization along with subsequent lower inpatient costs.…”

Section: Discussionsupporting

confidence: 89%

“…Xiao et al 32 reported that, upon comparison of PP1M and OAA users, PP1M use was linked to significantly lower medical costs, which offset the higher pharmacy cost of PP1M. Similar findings were also revealed by Pesa et al 34 and Pilon et al 33 , who investigated patients recently diagnosed with schizophrenia. The lower medical costs for the PP1M cohorts in previous studies appeared to be driven by the significantly lower inpatient costs [32][33][34] .…”

Section: Discussionsupporting

confidence: 52%

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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

Khoury

Patel

Huang

et al. 2019

Current Medical Research and Opinion

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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

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 52%

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

Khoury

Patel

Huang

et al. 2019

Current Medical Research and Opinion

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“…The observed increase in outpatient prescription costs may be attributed to the high cost of LAIs, which has been regarded as one of the most critical factors limiting clinical use of these drugs. However, previous real-world studies comparing healthcare utilization and costs between LAIs and OAT medications showed that high prescription costs are offset by reduced healthcare expenditure in patients treated with LAIs, suggesting that the use of PP may result in greater cost savings compared to the use of OAT medications [11,12,16]. Although the present study could not precisely quantify the costs of PP, we observed that a reduction in per patient per year admission costs (USD 1,220.75) could offset the increase in per patient per year prescription costs (USD 1,497.15) in PP-treated Korean patients.…”

Section: Discussionmentioning

confidence: 99%

“…Significant economic benefits of LAIs, due to the reductions in hospitalization rates, have recently been demonstrated in populations in the United States (US) and Europe [10][11][12][13]. Patients treated with PP had lower mean hospitalization costs (United States dollar [USD] 18,560) compared to those treated with OAT medications (USD 31,505) [10].…”

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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“…PP1M was shown to improve adherence and delay treatment failure compared to OAAs in a recent clinical trial [10]. Similarly, PP1M was shown to improve adherence and reduce economic burden compared to OAAs in the real world [6,8,[11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Adherence, Healthcare Resource Utilization, and Costs in Medicaid Beneficiaries with Schizophrenia Transitioning from Once-Monthly to Once-Every-3-Months Paliperidone Palmitate

Émond

Joshi

Khoury

et al. 2018

PharmacoEconomics Open

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Objectives The aim was to compare adherence to antipsychotics (APs), healthcare resource utilization (HRU), and costs before and after once-every-3-months paliperidone palmitate (PP3M) initiation in patients with schizophrenia. Methods Medicaid data (Iowa, Kansas, and Missouri; 1/2014-3/2017) were used to identify adults with at least one PP3M claim, ≥ 12 months of pre-index enrollment, and at least two schizophrenia diagnoses. Adequate treatment with once-monthly paliperidone palmitate (PP1M) was required pre-PP3M transition. Generalized estimating equations were used to assess linear trends in adherence to APs, HRU, and costs over the four quarters pre-PP3M transition, and to compare monthly HRU and costs 6 months pre-and 12 months post-PP3M transition as well as adherence to APs 12 months pre-and post-PP3M transition. Results Among 324 patients initiated on PP3M, the mean age was 41.4 years and 36.1% were females. Over the four quarters pre-PP3M transition, the monthly number of emergency room visits, medical costs, and inpatient costs decreased, while pharmacy costs and adherence to APs increased. For patients with ≥ 12 months of follow-up (n = 151), adherence to APs (66.2 vs. 70.2%, p = 0.3758), total (US$3371 vs. US$3456; p = 0.7000), pharmacy (US$1805 vs. US$1870; p = 0.2960), and medical costs (US$1565 vs. US$1586; p = 0.9040) remained similar pre-and post-PP3M transition, while mean monthly number of 1-day mental institute visits (1.71 vs. 1.51; p < 0.01) and associated costs (US$260 vs. US$232, p = 0.01) decreased. Conclusions Adherence to APs, HRU, and costs were similar pre-and post-PP3M transition, suggesting that PP3M has no impact on monthly costs for patients adequately treated with PP1M, with the added flexibility of once-every-3-months dosing. Key Points for Decision MakersOver the four quarters before once-every-3-months paliperidone palmitate (PP3M) transition, adherence to antipsychotics significantly improved and the increase in pharmacy costs was offset by decreasing medical costs, driven by a decrease in inpatient costs.Adherence to antipsychotics, monthly healthcare resource utilization, and monthly Medicaid spending remained similar before and after PP3M transition. These findings suggest that for patients adequately treated with once-monthly paliperidone palmitate, the transition to PP3M has no impact on monthly healthcare costs, with the added flexibility of once-every-3-months dosing.

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Health care resource utilization and costs of California Medicaid patients with schizophrenia treated with paliperidone palmitate once monthly or atypical oral antipsychotic treatment

Cited by 27 publications

References 35 publications

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

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

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

Adherence, Healthcare Resource Utilization, and Costs in Medicaid Beneficiaries with Schizophrenia Transitioning from Once-Monthly to Once-Every-3-Months Paliperidone Palmitate

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