Adherence Improved
Adherence to oral antipsychotics in the cohorts prior to the medication change was 16.4% and 11% based on proportion of days covered and 25.7% and 22.1% using the medication possession ratio greater than 80% measure, for the first and second cohorts, respectively. In the 12 months after the switch, adherence rose to 39.5% and 27% for days covered and 49.6% and 35.9% for medication possession ratio, for the six-month and 12-month cohorts.
The number of all-cause inpatient stays was halved after the switch in the 12-month cohort, from an average of 2.2 to 1.1, and the mean length of stay also dropped substantially, from 28.1 days to 14.0 days. Similar changes were seen in the subsets of mental health-related and schizophrenia-related hospitalizations. Overall costs of inpatient stays plummeted from $41,886 to $20,489. Outpatient visit costs rose from $22,005 to $29,069. Comparable changes were seen in the six-month cohort.
“In this retrospective study involving patients from the VHA database, increased adherence was associated with better control of schizophrenia, and, after the switch to PP1M, patients had fewer all-cause, [mental health]-related, and schizophrenia-related inpatient stays,” the authors said.
Patients using LAIs had more outpatient visits, as expected with monthly injections, and had increased pharmacy costs. These increased costs, however, were offset by fewer inpatient stays, shorter hospital stays and reduced inpatient care costs. The savings increased over time, with mean all-cause total costs, including inpatient, outpatient and pharmacy costs declining from $66,980 to $61,670 from the year before the switch of medications to the year after.
The cost savings indicated in this study support earlier findings that veterans with schizophrenia treated with once-monthly paliperidone palmitate (PP1M) had average annual all-cause total healthcare costs of $78,589 compared to $82,895 for those on oral antipsychotic medications.
For the VA, the reduction in number and length of hospitalization is particularly important. A 2019 VA study discovered that veterans with schizophrenia typically occupy more hospital beds than veterans with any other illness, creating a significant, ongoing burden.
Reducing hospitalizations not only cuts costs, it often indicates a general improvement in quality of life associated with better management of this severe mental illness.
“With the administration of LAIs, such as PP1M, patients may have improved adherence owing to a sense of responsibility about keeping outpatient appointments, and without the burden of remembering daily oral medications,” they added. “The findings from this VHA population suggest that these factors may contribute to enhanced management of schizophrenia in clinical practice.”
- Patel C, Khoury AE, Huang A, Wang L, Bashyal R. Healthcare Resource Utilization and Costs Among Patients With Schizophrenia Switching From Oral Risperidone/Paliperidone to Once-Monthly Paliperidone Palmitate: A Veterans Health Administration Claims Analysis. Curr Ther Res Clin Exp. 2020;92:100587. Published 2020 Apr 19. doi:10.1016/j.curtheres.2020.100587