Treatment Patterns, Healthcare Resource Utilization and Costs Among Schizophrenia Patients Treated with Long-Acting Injectable Versus Oral Antipsychotics

Shah, Ankit; Xie, Lin; Kariburyo, Furaha; Zhang, Qisu; Gore, Mugdha

doi:10.1007/s12325-018-0786-x

Cited by 32 publications

(46 citation statements)

References 38 publications

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“…The study revealed findings such as a reduction in inpatient stays along with shorter inpatient length of stay, as well as reduction in inpatient costs, total medical costs, and total costs after the transition to PP1M. The findings of this current study are consistent with numerous previous studies that have compared the use of PP1M and OAAs in general by comparing treatment cohorts and have reported similar outcomes to the current study, such as reductions in inpatient stay, improved adherence, increased pharmacy cost due to PP1M, and lower medical costs 9,17,32,33 . Moreover, a recent study using a decision-tree model to grasp patient pathways related to costs reported that patients with schizophrenia on OAA with a recent relapse who switched to PP1M resulted in reduced relapse rates and net healthcare cost savings, which offset the pharmacy cost associated with PP1M 27 .…”

Section: Discussionsupporting

confidence: 90%

“…Significantly lower all-cause inpatient, total medical, and total costs were also observed post-PP1M initiation; however, higher costs were observed for pharmacy and outpatient visits. These findings are further supported by previous studies and can be attributed to the higher cost of PP1M compared to OAAs in addition to more patients having a higher level of adherence and making more outpatient visits to receive the PP1M administration 8,17,31,32 . Additionally, MH-and schizophrenia-related costs exhibited similar trends.…”

Section: Discussionsupporting

confidence: 85%

“…These findings were also reflected in similar trends for MH-and schizophreniarelated HRU (results not shown). Shah et al 17 compared recently-diagnosed schizophrenia patients prescribed LAIs or OAAs and observed that patients prescribed LAIs (such as PP1M) had fewer inpatient admissions, ER visits, and days in the hospital compared to patients prescribed OAAs. 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.…”

Section: Discussionmentioning

confidence: 99%

“…Shah et al 17 compared recently-diagnosed schizophrenia patients prescribed LAIs or OAAs and observed that patients prescribed LAIs (such as PP1M) had fewer inpatient admissions, ER visits, and days in the hospital compared to patients prescribed OAAs. 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] .…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies have demonstrated the clinical and economic advantage of LAIs, such as PP1M, over OAA use in patients with schizophrenia, specifically through the reduction of experienced relapses, hospitalizations, and significantly lower HRU and healthcare costs 16,17 . However, there is a lack of evidence specifically discussing patients with schizophrenia and at least one prior hospitalization who have transitioned from oral risperidone or paliperidone (oral ris/pali) to PP1M in a real-world setting.…”

Section: Introductionmentioning

confidence: 99%

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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: 90%

Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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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Impact of schizophrenia relapse definition on the comparative effectiveness of oral versus injectable antipsychotics: A systematic review and meta‐analysis of observational studies

Cristarella

Castillon

Nepveu

et al. 2022

Pharmacology Res & Perspec

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Although relapse is an important outcome to measure the effectiveness of schizophrenia treatment, no standard definition exists. This review aimed at identifying definitions and measurements of schizophrenia relapse in observational studies of long‐acting injectables (LAIs) versus oral antipsychotics (OAPs) and at determining their impact on heterogeneity of comparative effectiveness estimates. A systematic review was conducted using MEDLINE and Embase (01 January 2010–11 November 2019 [date last searched]). Pragmatic searches of gray literature and snowballing were also conducted. Search outputs were screened independently by two assessors at first stage, and full‐text of potentially eligible sources at second stage. For each retained source, definition and measurement of relapse, study methods, and comparative effectiveness estimates were extracted. Heterogeneity of estimates was assessed using I2 statistic with a threshold of 50% for substantial heterogeneity. Literature search yielded 543 sources and pragmatic searches, 21, of which 35 were eligible. Twelve definitions of relapse were found based on hospitalization/emergency department (ED) data (28 studies) or clinical assessment (5 studies). No definition was provided in five studies. According to quantitative analyses, in studies defining relapse as schizophrenia‐related hospitalization and/or ED visits over 1‐year follow‐up, LAIs were significantly more effective than OAPs. For studies measuring relapse based on all‐cause hospitalization, heterogeneity was too high for pooling; yet this definition is the most frequently found in pooled estimates published in the literature. Schizophrenia relapse definitions led to substantial heterogeneity of comparative effectiveness estimates of LAIs versus OAPs. Creating study subgroups based on relapse definition effectively reduces statistical heterogeneity.

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One-Year Medication Treatment Patterns, Healthcare Resource Utilization, and Expenditures for Medicaid Patients with Schizophrenia Starting Oral Atypical Antipsychotic Medication

Richards,

Johnsrud,

Zacker

et al. 2023

Adm Policy Ment Health

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Oral atypical antipsychotic (OAAP) medications are the most commonly prescribed treatment for the management of schizophrenia symptoms. This retrospective study, using Medicaid claims data (2016–2020), followed patients for 12 months after initiating OAAP therapy. Study outcomes included OAAP adherence, switching, augmentation, healthcare resource utilization (HRU), and expenditures. All-cause and schizophrenia-related HRU and expenditures were compared between adherent and nonadherent cohorts. Among 13,007 included patients (39.1 ± 12.8 years of age, 57.0% male, 36.1% Black, 31.8% White, 9.7% Hispanic), 25.7% were adherent to OAAPs (proportion of days covered [PDC] ≥ 0.8). During the 1-year follow-up period, Black individuals were in possession of an OAAP for an average of 166 days compared to 198 and 202 days for White and Hispanic patients, respectively. Approximately 16% of patients switched OAAP medications and 3.2% augmented therapy with an OAAP added to their index medication. Nearly 40% of patients were hospitalized during follow-up and 68.4% had emergency department (ED) visits. A greater proportion of nonadherent patients had all-cause inpatient (41.7% vs. 34.1%, p < 0.001) and ED visits (71.7% vs. 58.8%, p < 0.001) compared to adherent patients. Annual total healthcare expenditures were $21,020 per patient; $3481 higher for adherent versus nonadherent patients. Inpatient expenditures comprised 44.6% and 30.6% of total expenditures for nonadherent and adherent patients, respectively. Hospitalized patients’ total expenditures were $23,261 higher compared to those without a hospitalization. Adherence to OAAP medication is suboptimal and associated with increased utilization of costly hospital and ED resources. Efforts to improve therapies and increase medication adherence could improve clinical and economic outcomes among individuals with schizophrenia.

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Treatment Patterns, Healthcare Resource Utilization and Costs Among Schizophrenia Patients Treated with Long-Acting Injectable Versus Oral Antipsychotics

Cited by 32 publications

References 38 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

Impact of schizophrenia relapse definition on the comparative effectiveness of oral versus injectable antipsychotics: A systematic review and meta‐analysis of observational studies

One-Year Medication Treatment Patterns, Healthcare Resource Utilization, and Expenditures for Medicaid Patients with Schizophrenia Starting Oral Atypical Antipsychotic Medication

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