Healthcare utilization and costs of veterans health administration patients with schizophrenia treated with paliperidone palmitate long-acting injection or oral atypical antipsychotics

Abstract

Objective:

This study aimed to compare real world healthcare costs and resource utilization between patients with schizophrenia treated with paliperidone palmitate long-acting injection (PP) and oral atypical antipsychotics (OAT).

Methods:

Patients (18–64 years) were selected from the Veterans Health Administration dataset (1 July 2007–31 May 2012). Patients with 2+ claims for PP or 2+ claims for the same OAT comprised the two study cohorts with the first prescription date designated as the index date. Participation in the VA healthcare system for 24 months pre- and 12 months post-index, schizophrenia diagnosis (International Classification of Disease 9th Revision Clinical Modification [ICD-9-CM] code 295.1x–6x, 295.8x–9x) and ≥1 claim for an antipsychotic medication during the baseline period were required. Propensity scores and Mahalanobis metric distances with calipers were used to create two matched cohorts. All-cause healthcare utilization and costs for the 12-month follow-up period were compared between matched cohorts.

Results:

The matching process produced two cohorts of 335 patients with similar baseline characteristics. During the 12-month follow-up period, patients in the PP cohort had lower mean inpatient costs (18,560 vs $31,505, p = 0.002), lower frequency of hospitalization (34% vs 53%, p < 0.001) and fewer average inpatient days (13.24 vs 24.18, p = 0.002) vs matched OAT patients. While mean pharmacy costs were higher for the PP cohort ($10,063 vs $4167, p < 0.001), mean total healthcare costs were not significantly different ($45,529 vs $52,569, p = 0.128).

Conclusion:

VA patients, diagnosed with schizophrenia and treated with PP, had lower inpatient costs and admission rates compared to a matched cohort of OAT patients. Total healthcare costs were not significantly different.

Keywords::

• Schizophrenia
• Paliperidone palmitate
• Long-acting antipsychotics
• Oral atypical antipsychotics
• Hospitalization
• Healthcare cost

Transparency

Declaration of funding

This study was funded by Janssen Scientific Affairs.

Declaration of financial/other relationships

JP & MD are employees of Janssen Scientific Affairs. OB & LX are employees of STATinMED Research, a paid consultant for Janssen Scientific Affairs.

Acknowledgments

Portions of this manuscript and an initial statistical analysis were presented as posters: (1) Healthcare use and costs of patients with schizophrenia in a VA population treated with paliperidone palmitate or atypical oral antipsychotics. Poster presented at the American Psychiatric Association 65th Institute on Psychiatric Services (IPS), October 10–13, 2013, Philadelphia, PA; and (2) A comparison of healthcare utilization and costs of schizophrenia patients treated with paliperidone palmitate long-acting injection or atypical oral antipsychotics within the Veterans Health Administration. Poster presented at the 26th Annual US Psychiatric and Mental Health Congress, September 30–October 3, 2013, Las Vegas, NV.