Treatment persistence and hospitalization rates among patients with schizophrenia: a quasi-experiment to evaluate a patient information program

Abstract

Objective: The effective treatment of schizophrenia requires continuous antipsychotic maintenance therapy. However, poor persistence with treatment is common among patients with schizophrenia. The objective of this study was to compare persistence and hospitalization rates among patients with schizophrenia treated with long-acting injectable (LAI) antipsychotics (i.e. paliperidone palmitate and risperidone) and enrolled in a patient information program (program cohort) with patients treated with oral antipsychotics (OAs) who were not enrolled in a patient information program (nonprogram cohort).

Research design and methods: Using a quasi-experimental design, data from chart reviews (for program patients) and Medicaid claims (for nonprogram patients) was analyzed. Patients were eligible if they had ≥12 months of pre-index data, ≥6 months of post-index data, and no hospitalization at index.

Main outcome measures: Persistence and hospitalization rates were assessed at 6 months post-index. Propensity score matching was used to control for observed differences in demographics and baseline clinical characteristics. Odds ratios (ORs) were calculated using generalized estimating equation models and adjusted for matched pairs and propensity score.

Results: A total of 102 program patients were matched to 408 nonprogram patients with similar baseline characteristics. Adjusted ORs indicated that the persistence rate at 6 months was significantly higher for the program cohort (88.2%) versus the nonprogram cohort (43.9%; OR: 9.70; P < .0001). The 6 month post-index hospitalization rate for the program cohort (14.7%) was significantly lower versus the nonprogram cohort after adjustments (22.5%; OR: 0.55; P = 0.0321).

Limitations: The data for the program and nonprogram patients were from two different and independent data sources (healthcare claims and chart reviews, respectively). Results were based on a relatively small number of program LAI patients.

Conclusion: Program patients treated with LAI antipsychotics had higher persistence rates and significantly lower adjusted hospitalization rates compared with nonprogram patients treated with OAs.

Keywords:

• Antipsychotics
• hospitalization
• long-acting injectable
• patient assistance program
• persistence
• schizophrenia

Transparency

Declaration of funding

This research was conducted as part of a consulting agreement with Janssen Scientific Affairs LLC.

Declaration of financial/other relationships

D.P., G.G., M.L., and P.L. have disclosed that they are employees of Groupe d’analyse Ltée, a consulting company that has received research grants from Janssen Scientific Affairs LLC. T.B.A. and C.J.B. have disclosed that they are employees of Janssen Scientific Affairs LLC and are Johnson & Johnson stockholders.

CMRO peer reviewers on this manuscript have received an honorarium from CMRO for their review work, but have no relevant financial or other relationships to disclose.

Acknowledgments

Editorial and writing support was provided by Matt Gryzwacz PhD and Lynn Brown PhD of ApotheCom (Yardley PA).

Previous presentation: Results were presented at the 2016 American Society of Health-System Pharmacists Summer Meetings and Exhibition, Baltimore, MD, USA, 11–15 June 2016.