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

Abstract

Objective: To compare all-cause health care utilization and costs between patients with schizophrenia treated with once monthly paliperidone palmitate (PP1M; Invega Sustenna¹) and atypical oral antipsychotic therapy (OAT).

Methods: This was a retrospective claims-based analysis among adult California Medicaid (Medi-Cal) patients with schizophrenia having ≥2 claims for PP1M or OAT from 1 July 2009 to 31 December 2013 and continuous health plan enrollment for ≥1 year pre- and post-index date (PP1M or OAT initiation date). Baseline characteristics were reported descriptively. Propensity score matching with a 1:1 greedy match method was used to create two matched cohorts. Treatment patterns, all-cause health care utilization, and costs for the 12 month follow-up period were compared between the two matched cohorts.

Results: Two well matched cohorts of 722 patients were produced with similar baseline characteristics. During the 12 month follow-up period, PP1M patients were significantly less likely to discontinue treatment (30.6% vs. 39.5%, p < .001) or switch to a new therapy (21.6% vs. 27.7%, p = .007). PP1M patients had fewer inpatient visits (5.0 vs. 7.9, p < .001), lower mean hospitalization days (15.0 vs. 27.7 days, p < .001) and inpatient costs ($5060 vs. $10,880, p < .001). While pharmacy costs were significantly higher in the PP1M cohort ($16,347 vs. $9115, p < .001), total costs were not significantly different between the matched cohorts ($25,546 vs. $25,307, p = 0.853).

Conclusions: Patients with schizophrenia treated with PP1M had significantly fewer inpatient hospitalizations and associated costs with no significant difference in the total costs between the two cohorts. This study is subject to limitations associated with claims data such as miscoding, inability to examine clinical severity, etc.

Keywords:

• Antipsychotics
• cost comparison
• drug therapy
• health care utilization
• paliperidone palmitate
• schizophrenia

Transparency

Declaration of funding

This study was funded by Janssen Scientific Affairs LLC. Janssen Scientific Affairs participated in the design of the study, the interpretation of data, and in writing the manuscript.

Author contributions: All authors conceived of the study design. L.W. and O.B. analyzed and interpreted the data. All authors contributed to the writing of this manuscript. All authors read and approved the final manuscript.

Declaration of financial/other relationships

J.A.P. and D.D. have disclosed that they are paid employees of Janssen Scientific Affairs LLC. L.W. and O.B. have disclosed that they are employees of STATinMED Research, which is a paid consultant to Janssen Scientific Affairs LLC. H.Y. has disclosed that he is a paid consultant to STATinMED Research, which is a paid consultant to Janssen Scientific Affairs LLC.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors would like to thank Sulena Shrestha and Chris Haddlesey of STATinMED Research for assistance with the writing and editing of this manuscript.

Notes

Notes

1 Invega Sustenna is a registered trade name of Janssen Pharmaceuticals, Inc Titusville, NJ

2 Risperdal Consta (Janssen Pharmaceuticals, Inc., Titusville, NJ)

3 Zyprexa Relprevv (Eli Lilly & Co, Indianapolis, IN)

4 Abilify (Otsuka America Pharmaceutical, Inc, Rockville, MD )

5 Haldol (various), and Prolixin (various)