Exploratory analysis of psychiatric-related utilization and costs associated with paliperidone ER compared with other oral atypical antipsychotics using pharmacy claims from an administrative database

Figures & data

Figure 1.  Study flowchart.

Table 1.  ICD-9 codes used for the resource utilization and costs analysis.

ICD-9 codes
290.xx–299.xx: Psychoses	290: Dementias
	291: Alcohol-induced mental disorders
	292: Drug-induced mental disorders
	293: Transient mental disorders due to conditions classified elsewhere
	294: Persistent mental disorders due to conditions classified elsewhere
	295: Schizophrenic disorders
	296: Episodic mood disorders
	297: Delusional disorders
	298: Other non-organic psychoses
	299: Pervasive developmental disorders
300.xx–316.xx: Neurotic disorders, personality disorders and other non-psychotic mental disorders	300: Anxiety, dissociative and somatoform disorders
	301: Personality disorders
	302: Sexual and gender identity disorders
	303: Alcohol dependence syndrome
	304: Drug dependence
	305: Non-dependent abuse of drugs
	306: Physiological malfunction arising from mental factors
	307: Special symptoms or syndromes, not elsewhere classified
	308: Acute reaction to stress
	309: Adjustment reaction
	310: Specific non-psychotic mental disorders due to brain damage
	311: Depressive disorder, not elsewhere classified
	312: Disturbance of conduct, not elsewhere classified
	313: Disturbance of emotions specific to childhood and adolescence
	314: Hyperkinetic syndrome of childhood
	315: Specific delays in development
	316: Psychic factors associated with diseases classified elsewhere
317.xx–319.xx: Mental retardation	317: Mild mental retardation
	318: Other specified mental retardation
	319: Unspecified mental retardation

Table 2.  Baseline patient demographics.

Parameter	Total sample (N = 562)
Mean age, years (SD)	43.5 (13.9)
Female, n (%)	350 (62.3)
Race/ethnicity, n (%)
Non-Hispanic Caucasian	240 (76.9)
Other	30 (9.6)
Hispanic	19 (6.1)
African American	15 (4.8)
Asian	8 (2.6)
Missing	250 (44.5)
Geographic region, US, n (%)
New England	14 (2.5)
Mid-Atlantic	27 (4.8)
East North Central	44 (7.8)
West North Central	85 (15.1)
South Atlantic	205 (36.5)
East South Central	22 (3.9)
West South Central	90 (16.0)
Mountain	55 (9.8)
Pacific	20 (3.6)
Household income, n (%)
<$30,000	41 (14.3)
$30,000–49,999	42 (14.6)
$50,000–69,999	66 (23.0)
$70,000-99,999	52 (18.1)
≥$100,000	86 (30.0)
Missing	275 (48.9)

Percentages for race/ethnicity and household income are based on patients with complete data.

Table 3.  Baseline clinical characteristics and resource utilization.

Parameter	Total sample (N = 562)
Co-morbidities, n (%)
Anxiety disorders	145 (25.8)
Heart disease	145 (25.8)
Hypertension	122 (21.7)
Diseases of arteries, arterioles and capillaries	73 (13.0)
Diabetes mellitus without complication	65 (11.6)
Miscellaneous psychiatric disorders	59 (10.5)
Screening and history of mental health and  substance abuse codes	56 (10.0)
Alcohol-related disorders	51 (9.0)
Liver disease	49 (8.7)
Suicide and intentional self-inflicted injury	47 (8.4)
Diabetes mellitus with complications	36 (6.4)
Cerebrovascular disease	33 (5.9)
Personality disorders	28 (5.0)
Substance-related disorders	20 (3.6)
Attention deficit, conduct and disruptive  behavior disorders	17 (3.0)
Delirium, dementia and amnesic and  other cognitive disorders	12 (2.1)
Use of any psychiatric medication, n (%)	509 (90.6)
Use of typical antipsychotics, n (%)	44 (7.8)
Atypical persistence, mean (SD)	20.7 (45.0)
Adherence, MPR, mean (SD)	0.11 (0.23)
Use of previous typical antipsychotics, n (%)
Risperidone	53 (9.5)
Aripiprazole	47 (8.4)
Olanzapine	12 (2.1)
Ziprasidone	7 (1.3)
Quetiapine	21 (3.7)
Switch in atypical antipsychotic, n (%)	12 (2.1)
Psychiatric-related inpatient stay count, mean (SD)	0.2 (0.5)
Psychiatric-related ER visit count, mean (SD)	1.8 (4.8)
Psychiatric-related ambulatory visit count, mean (SD)	4.8 (7.4)

Table 4.  Psychiatric-related utilization outcomes: paliperidone ER cohort versus atypical antipsychotic cohorts.

Utilization	Paliperidone ER (n = 95)	Aripiprazole (n = 94)	Olanzapine (n = 89)	Quetiapine (n = 95)	Riperidone (n = 94)	Ziprasidone (n = 95)
Patients with ≥1 inpatient facility admission, n (%)	6 (6.3)	4 (4.3)	12 (13.5)	11 (11.6)	7 (7.5)	12 (12.6)
Patients with ≥1 emergency room visit, n (%)	28 (29.5)	32 (34.0)	31 (34.8)	25 (26.3)	28 (29.8)	29 (30.5)
Patients with ≥1 ambulatory visit, n (%)	70 (73.7)	71 (75.5)	60 (67.4)	67 (70.5)	63 (67.0)	66 (69.5)
Number of inpatient facility admissions, mean (SD)	0.07 (0.3)	0.06 (0.3)	0.17 (0.5)	0.20 (0.9)	0.10 (0.4)	0.15 (0.4)
Number of emergency room visits, mean (SD)	1.8 (3.8)	2.6 (5.9)	2.1 (5.7)	1.6 (3.8)	2.1 (7.6)	2.1 (5.0)
Number of ambulatory visits, mean (SD)	4.6 (5.8)	5.0 (6.2)	7.0 (12.1)	4.9 (6.5)	6.9 (10.1)*	6.2 (9.1)

*p = 0.05 paliperidone ER vs. risperidone.

Table 5.  Mean psychiatric-related costs per patient over 6 months.

Psychiatric-related costs in US dollars, mean (SD)	Paliperidone ER (n = 95)	Aripiprazole (n = 94)	Olanzapine (n = 89)	Quetiapine (n = 95)	Risperidone (n = 94)	Ziprasidone (n = 95)
Medical	753 (1,589)	1,425 (4,836)	2,019 (4,473)	1,832 (4,386)*	1,656 (4,369)	1,817 (3,674)*
Pharmacy	2,758 (1,890)	2,963 (1,680)	2,782 (1,919)	2,145 (1,520)*	2,250 (1,759)*	2,742 (1,403)
Total health care	3,510 (2,458)	4,388 (5,226)	4,800 (5,139)*	3,977 (4,778)	3,906 (4,645)	4,559 (3,975)*

*p ≤ 0.05, paliperidone ER vs. the respective atypical antipsychotic.