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

Abstract

Introduction Previous evidence demonstrated that patients with schizophrenia consumed substantial healthcare resources in an integrated healthcare system. This study evaluated the impact of initiating once-monthly paliperidone palmitate (PP1M) on healthcare resource utilization (HRU) among patients with schizophrenia treated in a US integrated healthcare system. Methods This retrospective study used electronic medical records from Atrium Health. Adults with at least two diagnoses of schizophrenia who received an initial PP1M dose between September 2009 and April 2019 (the corresponding date defined the index date) and at least one subsequent dose within 90 days were included. Additionally, patients were required to have received active care (at least one healthcare visit every 6 months) during 12-month pre- and post-index periods and at least one oral antipsychotic prescription during the 12-month pre-index period. Inpatient, emergency room (ER), and outpatient visits were compared over 12-month pre- versus post-index periods within the same cohort using McNemar’s and Wilcoxon signed rank tests. Findings were reported for all patients and separately in patients with at least one schizophrenia relapse (schizophrenia-related inpatient or ER visit) during the 12-month pre-index period. Results The study cohort included 210 patients (mean age 34.2 years, 69.5% male, 39.1% had Medicaid). From the 12-month pre- to post-index period, the proportion of patients with visits and mean number of visits reduced for all-cause inpatient (67.6% to 22.4%, 1.2 to 0.4), 30-day readmission (12.4% to 2.4%, 0.2 to 0.1), and ER (68.6% to 45.7%, 2.3 to 1.2) visits, whereas the mean number of outpatient visits increased (8.7 to 11.6) (all P < 0.05). Similar trends were observed for mental health- and schizophrenia-related HRU. The trends in HRU in patients with prior relapse were similar with a higher extent of reduction in inpatient and ER use compared to the overall cohort. Conclusion Initiation of PP1M was associated with reduced acute HRU in patients with schizophrenia, indicating potential clinical and economic benefits, especially in patients with prior relapse. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01626-9.

Healthcare resource utilization and costs before and after long-acting injectable antipsychotic initiation in commercially insured young adults with schizophrenia

“…A recent retrospective study of 210 patients with schizophrenia (mean age 34.2 years) based on the electronic medical records from Atrium Health in a US integrated healthcare system demonstrated a significant decrease in all-cause inpatient visits (67.6 to 22.4%, P < 0.001) and mean length of inpatient stay (14.2 ± 16.8 to 4.4 ± 13.2 days, P < 0.001) from the period before LAI initiation to 12 months after LAI initiation. Similar trends in mental health-related inpatient visits (67.6 to 22.4%, P < 0.001) and schizophrenia-related inpatient visits (61.4 to 20.5%, P < 0.001) were reported [ 40 ]. Another claim data study among US-based young adult Medicaid patients with schizophrenia reported 37% reduced all-cause inpatient admissions (odds ratio [OR], 0.63; 95% CI, 0.53–0.74) after initiating LAI compared to oral atypical antipsychotics cohort [ 29 ].…”

Second-Generation Antipsychotics’ Effectiveness and Tolerability: A Review of Real-World Studies in Patients with Schizophrenia and Related Disorders

“…Finally, only the study by [ 69 ] presented results on the effectiveness of LAI risperidone in a retrospective cohort study vs. all-oral SGAs and FGAs and vs. oral risperidone [ 69 ]. All the studies, including patients treated with PP1M, reported significant improvements in subjective well-being and global satisfaction, and improved personal and social performance [ 59 , 65 , 67 , 68 , 70 , 71 , 72 , 74 , 75 , 76 , 78 , 79 , 82 ]. Furthermore, functionality improvement was more remarkable in patients with a disease duration of 5 years or less [ 75 ].…”

“…Additionally, patients enrolled in other studies showed a low dropout rate, reduced acute healthcare use, and significantly improved neurocognitive function after 12 months of treatment with LAI SGAs, besides better effects on positive, negative, and affective symptoms, psychosocial functioning, and quality of life [ 79 , 82 ]. Furthermore, the transition from PP1M to PP3M evidenced a substantial decrease in combined medications and healthcare resource use, and increased adherence [ 74 ].…”

Results from PSIPROSPER: A multicenter retrospective study to analyze the impact of treatment with paliperidone palmitate 1-month on clinical outcomes and hospital resource utilization in adult patients with schizophrenia in Portugal

“…The same can be said of the tolerability and safety, as the number of discontinuations is very low and corroborates previous research ( 32 , 34 ), some of them with a very similar mirror design. Also, the outcomes in the hospital resources used to follow the trend of similarly designed studies in other countries, in which a significant decrease in resources was found ( 35 ). Concerning measures of treatment adherence and compliance, and although this was measured in the current study considering the proportion of patients that discontinued PP1M—a very low proportion—results follow previously published evidence ( 36 ).…”