Comparison of Medicaid spending in schizoaffective patients treated with once monthly paliperidone palmitate or oral atypical antipsychotics

Abstract

Background Compared to oral atypical antipsychotics (OAAs), long-acting injectable antipsychotics require less frequent administration, and thus may improve adherence and reduce risk of relapse in schizoaffective disorder (SAD) patients.

Objective To evaluate the impact of once monthly paliperidone palmitate (PP) versus OAAs on healthcare resource utilization, Medicaid spending, and hospital readmission among SAD patients.

Methods Using FL, IA, KS, MS, MO, and NJ Medicaid data (January 2009–December 2013), adults with ≥2 SAD diagnoses initiated on PP or OAA (index date) were identified. Baseline characteristics and outcomes were assessed during the 12month pre- and post-index periods, respectively. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used to reduce confounding and compare the estimated treatment effect for PP versus OAA.

Results A total of 10,778 OAA-treated patients and 876 PP-treated patients were selected. Compared to OAAs, PP was associated with significantly lower medical costs (PSM: mean monthly cost difference [MMCD] = -$383, p < 0.001; IPTW: MMCD = -$403, p = 0.016), which offset the higher pharmacy costs associated with PP (PSM: MMCD = $270, p < 0.001; IPTW: MMCD = $350, p < 0.001) and resulted in similar total healthcare cost (PSM: MMCD = -$113, p = 0.414; IPTW: MMCD = -$53, p = 0.697) for PP versus OAA. Reduced risk of hospitalization (PSM: incidence rate ratio [IRR] = 0.85, p = 0.128; IPTW: IRR = 0.96, p = 0.004) and fewer hospitalization days (PSM: IRR = 0.74, p = 0.008; IPTW: IRR = 0.85, p < 0.001) were observed in PP versus OAA patients. Among hospitalized patients, PP was associated with a lower risk of 30 day hospital readmission compared to OAA (IPTW: odds ratio = 0.89, p = 0.041).

Limitations The Medicaid data may not be representative of the nation or other states, and includes pre-rebate pharmacy costs (potentially over-estimated). Also changes in treatment over time were possible.

Conclusions Total healthcare costs associated with the use of once monthly PP versus OAAs appeared comparable; higher pharmacy costs for PP users were offset by lower medical costs related to fewer and shorter inpatients visits.

Keywords:

• Healthcare costs
• healthcare resource utilization
• long-acting injectable therapy
• oral atypical antipsychotics
• paliperidone palmitate
• propensity score analyses
• schizoaffective disorder

Declaration of funding

This research was funded by Janssen Scientific Affairs LLC.

Declaration of financial/other relationships

Y.X., M.-H.L., D.P., B.E., P.L., and M.S.D. have disclosed that they are employees of Analysis Group Inc., a consulting company that has received research grants from Janssen Scientific Affairs LLC. E.M., D.-J.F., and A.W. have disclosed that they are employees of Janssen Scientific Affairs LLC and Johnson & Johnson stockholders.

 CMRO peer reviewers on this manuscript have received an honorarium from CMRO for their review work. CMRO peer reviewer 1 has disclosed that he has received speaker honoraria from Janssen-Cilag, Eli Lilly, Sanofi-aventis, Otsuka and Lundbeck. He has also received travel or hospitality payments from Janssen-Cilag, Eli Lilly, Lundbeck, Johnson & Johnson, Pfizer, Bristol-Myers-Squibb, AstraZeneca and Novartis. He has participated in clinical trials for Janssen-Cilag, Eli Lilly, Lundbeck, Johnson & Johnson, Pfizer, Bristol-Myers-Squibb, AstraZeneca, Novartis, Servier, Pierre Fabre, Roche, Organon, and Merck. He has also participated on advisory boards or being a consultant to Janssen-Cilag, Eli Lilly, Lundbeck, Johnson & Johnson, Roche and Teva. CMRO peer reviewer 2 has no relevant financial or other relationships to disclose.

Acknowledgments

Previous presentation: Part of the material in this manuscript has been presented at the Academy of Managed Care Pharmacy's 27th Annual Meeting & Expo, 7–10 April 2015, San Diego, CA, USA.