Costs and Resource Utilization Among Medicaid Patients with Schizophrenia Treated with Paliperidone Palmitate or Oral Atypical Antipsychotics

被引：0
作者：
Pesa J.A. [1 ]
Muser E. [1 ]
Montejano L.B. [2 ]
Smith D.M. [2 ]
Meyers O.I. [2 ]
机构：
[1] Janssen Scientific Affairs, LLC, 3133 Castle Peak Ave. Superior, Louisville, 80027, CO
[2] Truven Health Analytics, Cambridge
来源：
Drugs - Real World Outcomes | 2015年 / 2卷 / 4期
关键词：
Schizophrenia; Asenapine; Inpatient Cost; Lurasidone; Medicaid Patient;
D O I：
10.1007/s40801-015-0043-4
中图分类号：
学科分类号：
摘要：
Background: Non-adherence to antipsychotic therapy among patients with schizophrenia is a key driver of relapse, which can lead to costly inpatient stays. Long-acting injectables (LAIs) may improve adherence, thus reducing hospitalizations, but inpatient cost reductions need to be balanced against higher drug acquisition costs of LAIs. Real-world evidence is needed to help quantify the economic value of oral atypical antipsychotics compared with LAIs. Objective: The objective of this study was to compare healthcare costs and resource utilization between once-monthly paliperidone palmitate (PP) and oral antipsychotic therapy (OAT) in a population of Medicaid beneficiaries with schizophrenia. Methods: A retrospective, observational study was performed using Truven Health MarketScan Medicaid claims data from 2009 to 2012. Marginal structural modeling, a form of weighted repeated measures analysis to control for differences between cohorts and time-varying confounding, was used to estimate monthly costs of care in 2012 US dollars and resource utilization over a 12-month period for patients in each cohort. Results: While per-month mental-health prescription costs were US$1019 higher in the PP cohort, approximately 55 % of this premium was offset by lower inpatient and outpatient care costs, producing a mean monthly total cost differential of US$434 (95 % CI 298–569, p < 0.0001) for all-cause costs and US$463 (95 % CI 374–552, p < 0.0001) for mental-health-related costs. Use of PP also resulted in a 0.44 and 0.47 reduction in the odds of all-cause and mental-health-related hospitalizations and a 0.09 reduction in the odds of all-cause emergency department visits (p < 0.0001, p < 0.0001, and p = 0.0134, respectively) over the 12-month follow-up period. Conclusions: Treatment with long-acting injectable antipsychotics, such as PP, may reduce inpatient and outpatient healthcare services utilization and associated costs. These findings also suggest that patients with schizophrenia taking once-monthly PP may stand a lower risk of hospitalization than patients on OAT. © 2015, The Author(s).
引用
收藏
页码：377 / 385
页数：8
相关论文
共 28 条
  • [1] McGuire T.G., Measuring the economic costs of schizophrenia, Schizophr Bull, 17, 3, pp. 375-388, (1991)
  • [2] Young A.S., Sullivan G., Burnam M.A., Brook R.H., Measuring the quality of outpatient treatment for schizophrenia, Arch Gen Psychiatry, 55, pp. 611-617, (1998)
  • [3] Wu E.Q., Birnbaum H.G., Shi L., Et al., The economic burden of schizophrenia in the United States in 2002, J Clin Psychiatry, 66, 9, pp. 1122-1129, (2005)
  • [4] Desai P.R., Lawson K.A., Barner J.C., Rascati K.L., Identifying patient characteristics associated with high schizophrenia-related direct medical costs in community-dwelling patients, J Manag Care Pharm, 19, 6, pp. 468-477, (2013)
  • [5] O'Malley A.J., Frank R.G., Normand S.-L.T., Estimating cost-offsets of new medications: use of new antipsychotics and mental health costs for schizophrenia, Stat Med, 30, 16, pp. 1971-1988, (2011)
  • [6] Almond S., Knap M., Francois C., Et al., Relapse in schizophrenia: costs, clinical outcomes and quality of life, Br J Psychiatry, 184, pp. 346-351, (2004)
  • [7] Karve S.J., Panish J.M., Dirani R.G., Et al., Health care utilization and costs among Medicaid-enrolled patients with schizophrenia experiencing multiple psychiatric relapses, Health Outcomes Res Med, 3, pp. 183-194, (2012)
  • [8] Chen E.Y., Hui C.L., Dunn E.L., Et al., A prospective 3-year longitudinal study of cognitive predictors of relapse in first-episode schizophrenic patients, Schizophr Res, 77, pp. 99-104, (2005)
  • [9] Weiden P.J., Kozma C., Grogg A., Et al., Partial compliance and risk of rehospitalization among California Medicaid patients with schizophrenia, Psychiatr Serv, 55, pp. 886-891, (2004)
  • [10] Brown J.D., Barrett A., Ireys H., Evidence-based practices for Medicaid beneficiaries with Schizophrenia and Biopolar disorder. No. 7490, Mathematica Policy Research, (2012)
123