Treatment patterns and Medicaid spending in comorbid schizophrenia populations: once-monthly paliperidone palmitate vs oral atypical antipsychotics.

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Treatment patterns and Medicaid spending in comorbid schizophrenia populations: once-monthly paliperidone palmitate vs oral atypical antipsychotics.

Curr Med Res Opin. 2018 Feb 16;:1-21

Authors: Kamstra R, Pilon D, Lefebvre P, Emond B, Joshi K

Abstract
OBJECTIVE: To compare treatment patterns and Medicaid spending between schizophrenia patients initiating once-monthly paliperidone palmitate (PP1M) and oral atypical antipsychotics (OAA) within four comorbid populations: cardiovascular disease (CVD), diabetes, hypertension, and obesity.
METHODS: Five-state Medicaid data identified comorbid adults with schizophrenia initiating PP1M or OAA (index) from 09/2009 balanced with inverse probability of treatment weighting. Chi-squared and t-tests compared index antipsychotic (AP) exposure (no gap >90 days) duration, AP polypharmacy, and index AP adherence (proportion of days covered≥80%) and persistence (no gap≥60 days) at 12 months post-index. Linear models with a non-parametric bootstrap procedure compared costs.
RESULTS: PP1M patients consistently had longer index AP exposure (e.g.
, CVD: 244 vs. 189 days;P<0.001) and less AP polypharmacy (e.g.
, CVD: 21.1% vs. 28.1%;P<0.001) versus OAA patients. Relative to OAA patients, adherence was more likely in PP1M patients with CVD or obesity (e.g.
, CVD: 28.6% vs. 22.1%;P<0.001) and less likely for patients with diabetes (22.0% vs. 24.4%;P = 0.031). Persistence was consistently more likely for PP1M versus OAA patients (e.g.
, CVD: 49.9% vs. 27.4%;P<0.001). Total costs were not significantly different between PP1M and OAA patients for any comorbidity. PP1M patients with diabetes, hypertension, or obesity had higher pharmacy and lower medical costs (all P<0.05).
CONCLUSIONS: Treatment with PP1M versus OAAs may reduce AP polypharmacy and increase AP persistence in comorbid patients with schizophrenia, without increasing total healthcare costs. Comorbidities are a highly prevalent driver of excess mortality in this vulnerable population; thus future studies should specifically address real-world effectiveness of therapies (including LAIs) for these patients.

PMID: 29452492 [PubMed - as supplied by publisher]

Treatment patterns and Medicaid spending in comorbid schizophrenia populations: once-monthly paliperidone palmitate vs oral atypical antipsychotics.

Related Articles

Treatment patterns and Medicaid spending in comorbid schizophrenia populations: once-monthly paliperidone palmitate vs oral atypical antipsychotics.

Curr Med Res Opin. 2018 Feb 16;:1-21

Authors: Kamstra R, Pilon D, Lefebvre P, Emond B, Joshi K

Abstract
OBJECTIVE: To compare treatment patterns and Medicaid spending between schizophrenia patients initiating once-monthly paliperidone palmitate (PP1M) and oral atypical antipsychotics (OAA) within four comorbid populations: cardiovascular disease (CVD), diabetes, hypertension, and obesity.
METHODS: Five-state Medicaid data identified comorbid adults with schizophrenia initiating PP1M or OAA (index) from 09/2009 balanced with inverse probability of treatment weighting. Chi-squared and t-tests compared index antipsychotic (AP) exposure (no gap >90 days) duration, AP polypharmacy, and index AP adherence (proportion of days covered≥80%) and persistence (no gap≥60 days) at 12 months post-index. Linear models with a non-parametric bootstrap procedure compared costs.
RESULTS: PP1M patients consistently had longer index AP exposure (e.g.
, CVD: 244 vs. 189 days;P<0.001) and less AP polypharmacy (e.g.
, CVD: 21.1% vs. 28.1%;P<0.001) versus OAA patients. Relative to OAA patients, adherence was more likely in PP1M patients with CVD or obesity (e.g.
, CVD: 28.6% vs. 22.1%;P<0.001) and less likely for patients with diabetes (22.0% vs. 24.4%;P = 0.031). Persistence was consistently more likely for PP1M versus OAA patients (e.g.
, CVD: 49.9% vs. 27.4%;P<0.001). Total costs were not significantly different between PP1M and OAA patients for any comorbidity. PP1M patients with diabetes, hypertension, or obesity had higher pharmacy and lower medical costs (all P<0.05).
CONCLUSIONS: Treatment with PP1M versus OAAs may reduce AP polypharmacy and increase AP persistence in comorbid patients with schizophrenia, without increasing total healthcare costs. Comorbidities are a highly prevalent driver of excess mortality in this vulnerable population; thus future studies should specifically address real-world effectiveness of therapies (including LAIs) for these patients.

PMID: 29452492 [PubMed - as supplied by publisher]