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

OBJECTIVE:

To compare treatment patterns and Medicaid spending between schizophrenia patients initiating once-monthly paliperidonepalmitate (PP1M) and oral atypical antipsychotics (OAAs) within four comorbid populations: cardiovascular disease (CVD), diabetes, hypertension and obesity.

METHODS:

Five-state Medicaid data identified comorbid adults with schizophrenia initiating PP1M or OAAs (index) from September 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 < .001) and less ap polypharmacy (e.g. cvd: 21.1% vs. 28.1%; p >< .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 >< .001) and less likely for patients with diabetes (22.0% vs. 24.4%; p =" .031)." persistence was consistently more likely for pp1m versus oaa patients (e.g. cvd: 49.9% vs. 27.4%; p >< .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 >< .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 the real-world effectiveness of therapies, including long acting injectable therapies (LAIs), for these patients.