WHITE RIVER JUNCTION, VT — Even though nearly half of all patients diagnosed with schizophrenia have a history of substance abuse (SA), data on treatment of schizophrenia with paliperidone palmitate (PP) among patients with comorbid SA have been limited.

A study published in the journal Clinical Therapeutics compared all-cause and SA-related healthcare resource utilization and costs in veterans with schizophrenia and co-occurring SA who were treated with PP vs.oral atypical antipsychotics (OAAs).1

A team including researchers from the White River Junction, VT, VAMC employed VHA electronic health record data to conduct a retrospective longitudinal study in veterans with schizophrenia who initiated PP or OAA between Jan. 1, 2010, and June 30, 2016. Participants had more than 12 months of enrollment before treatment initiation (baseline), were diagnosed with SA, and had one or fewer Global Assessment of Functioning score during baseline.

Researchers estimated adjusted cost differences and incidence rate ratios (IRR) for the association between PP vs. OAA and all-cause and SA-related healthcare costs and healthcare resource utilization in the 12 months after treatment initiation.

Results indicated that, of 6,872 veterans in the study, 1,684 (25%) and 5,188 (75%) were treated with PP and OAA, respectively.

After adjustment, PP was associated with fewer all-cause inpatient (IRR = 0.88), mental health-related inpatient (IRR = 0.88) and long-term care stays (IRR = 0.53) compared with OAA. It was associated with more frequent mental health intensive case management visits (IRR = 1.51), however.

At the same time, PP was associated with significantly lower rates of SA-related inpatient stays (IRR = 0.80), mental health stays (IRR = 0.85) long-term care stays (IRR = 0.22) and outpatient visits (IRR = 0.78) than OAA, study authors reported.

Treatment with PP also saved money compared to OAA, the report noted. Patients treated with PP also had lower mean annual all-cause $10,473 lower cost, and SA-related, $8,457 lower cost.

 “PP was associated with significant total medical cost savings resulting from fewer hospitalizations and lower rates of SA-related health care resource utilization compared with OAA in patients with schizophrenia and comorbid SA,” study authors concluded. “Thus, PP appears to be a valuable treatment option for patients in this subpopulation.”

1. Lefebvre P, Muser E, Joshi K, DerSarkissian M, Bhak RH, Duh MS, Shiner B,Young-Xu Y. Impact of Paliperidone Palmitate Versus Oral Atypical Antipsychotics on Health Care Resource Use and Costs in Veterans With Schizophrenia and ComorbidSubstance Abuse. Clin Ther. 2017 Jul;39(7):1380-1395.e4. doi:10.1016/j.clinthera.2017.05.356. Epub 2017 Jun 20. PubMed PMID: 28641996.