Paliperidone Palmitate vs. Oral Atypical Antipsychotics: Hospitalization, ER Visits Compared

Among members of Humana's Medicare Advantage and Prescription Drug plan who have schizophrenia, paliperidone palmitate (PP) was associated with fewer hospitalizations and ER visits than oral atypical antipsychotics (OAAs), and the resulting healthcare system savings offset half of the cost difference between PP and OAAs.

SAN ANTONIO, TX—The once-monthly long-acting antipsychotic paliperidone palmitate (PP) is associated with better treatment adherence and lower healthcare services utilization than oral atypical antipsychotics (OAAs) among Medicare recipients with schizophrenia, offsetting drug cost differences, according to findings from a retrospective database analysis presented at the U.S. Psychiatric & Mental Health Congress.

“The current study contributes to the existing body of literature by demonstrating lower rates of hospitalization and ER visits, lower medical costs, lower rates of medication discontinuation, and greater medication adherence in schizophrenia patients who indexed to PP vs. OAAs in a large national fully-insured Medicare Advantage health plan,” reported lead study author Kruti Joshi, MPH, of Janssen Scientific Affairs, LLC, in Titusville, NJ, and coauthors.

“PP demonstrated favorable real-world clinical and economic outcomes within the Medicare Advantage patients, who are generally much older than the national population,” they noted.

Prior research has shown that long-acting therapies (LATs) such as once-monthly PP can reduce hospitalization and emergency room (ER) services utilization among patients with schizophrenia—but effectiveness among Medicare beneficiaries has been relatively little-studied.

The authors therefore sought to examine treatment patterns, costs, and healthcare services utilization (hospitalizations and ER visits) among patients taking PP, and to compare these to outcomes for patients on OAAs.

They used Humana’s commercial and Medicare membership claims data for July 1, 2009 through September 30, 2014. Adult patients younger than age 86 years, with two or more PP or OAA pharmacy claims who were enrolled in the company’s Medicare Advantage and Prescription Drug plan were included in the study. Patients with prescriptions for clozapine were excluded from the analysis.

A total of 295 patients on PP were identified and 2,296 patients prescribed OAAs were identified.

“A significantly higher proportion of patients in the OAA group discontinued the index treatment compared to the PP group (59.2% vs. 50.3%; P<0.001),” the study authors reported. “PP patients had greater odds of being adherent (12-month PDC ≥0.8) to their medications compared to OAA patients (OR [Odds Ratio]: 1.92; CI: 1.62-2.27).”

PP patients were less likely to experience hospitalization, had significantly lower-numbers of mental health-related hospitalizations, lower numbers of ER visits, and a reduced risk of mental health-related ER visits, compared to OAA-group patients, the authors reported.

PP was also associated with lower average medical costs (P<0.001), offsetting half of its higher mean pharmacy cost, according to the authors. (“The percentage cost offset should be considered conservative since pharmacy costs did not account for branded drug discounts or rebates, which may have overestimated PP costs,” the authors noted.)

Their findings “suggest that PP used more broadly among Medicare patients with schizophrenia and eligible for OAAs could result in greater adherence and lower medical services utilization,” they concluded.

The study was funded by Janssen Scientific Affairs, LLC.