Adherence, Healthcare Resource Utilization, and Costs for Medicare Members with Schizophrenia and Treated with Paliperidone Palmitate versus Oral Atypical Antipsychotics

January 20, 2017

This poster was presented at the 29th Annual U.S. Psychiatric & Mental Health Congress, held October 21-24, 2016, in San Antonio, Texas.

OBJECTIVES: Paliperidone palmitate (PP) is a long-acting injectable medication for schizophrenia that is most often used following treatment with oral atypical antipsychotics (OAA). The objectives of this study were to compare adherence, healthcare resource utilization, and costs of patients with schizophrenia treated with PP versus OAA.

METHODS: The Humana Research Database was used to identify Medicare Advantage patients with schizophrenia and treated with PP or an OAA during July 1, 2009 - September 30, 2014.  Inverse Probability of Treatment Weights using 6-month baseline measures for propensity score models were used to create weighted PP and OAA cohorts.  Logistic regression models were used to compare adherence, hospitalization, and emergency room (ER) visits during the 12 months post-index. Poisson regression models were used to compare number of hospitalizations and ER visits.  Generalized linear models with a log link and gamma distribution were used to compare medical and pharmacy costs.

RESULTS: The PP (n=295) and OAA (n=2,296) cohorts were weighted resulting in sums of weights of 1,087 and 1,190 respectively.  PP patients had higher odds of being adherent (OR=1.92; CI=1.62-2.27), lower odds and lower incidence rate of hospitalization (OR=0.81; CI=0.68-0.96; IRR=0.73 CI=0.64-0.83), lower mean medical costs (−$4,456; p<0.001), and higher mean pharmacy costs ($9,006; p<0.001).

CONCLUSIONS: PP may provide benefits over OAAs such as higher adherence, fewer hospitalizations, and lower medical costs which offset 50% of the higher pharmacy costs within 12 months of therapy in Medicare Advantage patients. The pharmacy costs do not account for branded drug discounts or rebates.

Kruti Joshi, MPH; Erik Muser, PharmD, MPH; Yihua Xu, PhD; Phil Schwab, PhD; Manasi Datar, PhD; Brandon Suehs, PharmD, PhD
Sponsoring Organization: 
Janssen Scientific Affairs LLC
Presented By: 
Kruti Joshi, MPH, Associate Director, Janssen Scientific Affairs LLC, Titusville, NJ
Assessment & Adherence