Cost-Effectiveness of Paliperidone Palmitate in Schizophrenia With Cardiometabolic Comorbidities

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Although all-cause pharmacy costs were higher in the paliperidone palmitate group, adjusted all-cause medical costs were lower.

The results of a study published in Drugs – Real World Outcomes demonstrated that in Medicaid beneficiaries with schizophrenia and cardiometabolic comorbidities who were initiated on once-monthly paliperidone palmitate, total 12-month healthcare costs were similar to those incurred by patients receiving oral atypical antipsychotic medications.

Marie-Helene LaFeuille, MA Economics, of the Group d’Analyse in Montreal, Quebec, Canada, and colleagues used Medicaid data from 6 states between July 2009 and March 2015 to identify adults with schizophrenia and cardiometabolic comorbidities who took once-monthly paliperidone palmitate or an oral atypical antipsychotic medication in January 2010 or later. They compared persistence to the index medication at 12 months, defined as no gap lasting more than 90 days, between the 2 medication groups using chi-squared tests. The investigators also compared the 12-month postindex healthcare costs and healthcare resource utilization using multivariate ordinary least squares and Poisson regression, respectively.

The researchers identified 371 patients taking once-monthly paliperidone palmitate and 8296 patients taking oral atypical antipsychotics. Twelve-month persistence was higher in patients taking paliperidone palmitate (40% vs 33%; P =.006). Although all-cause pharmacy costs were higher in the paliperidone palmitate group (mean monthly cost difference = $279; P <.001), adjusted all-cause medical costs were lower among patients receiving once-monthly paliperidone palmitate than among those receiving atypical antipsychotic medications (mean monthly cost differences=$–369; P =.004), resulting in no significant difference in total costs (mean monthly cost differences=$–90; P =.357). Furthermore, no significant difference was observed in cardiometabolic comorbidity-related pharmacy or medical costs.

The investigators also noted that compared with patients taking atypical antipsychotics, patients taking paliperidone palmitate had more schizophrenia-related outpatient visits (incidence rate ratio=1.44; P <.001) but fewer cardiometabolic comorbidity-related inpatient admissions (incidence rate ratio=0.73; P <0.001) with shorter lengths of stay (incidence rate ratio=0.72; P =.020) as well as fewer cardiometabolic comorbidity-related long-term care admissions (incidence rate ratio=0.56; P =.0016).

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Study limitations included the heterogeneous nature of the study population and that persistence to atypical antipsychotic medication may have been overestimated in comparison with paliperidone palmitate, which was administered in a clinical setting. In addition, precise reasons for treatment discontinuation were not available, and the Medicaid databases may have contained inaccuracies.

Given these findings, however, the authors suggest that future studies to characterize the relationship between paliperidone palmitate and oral atypical antipsychotic medications in patients with schizophrenia and cardiometabolic comorbidities are warranted.


LaFeuille M-H, Tandon N, Tiggelaar S, et al. Economic impact in Medicaid beneficiaries with schizophrenia and cardiometabolic comorbidities treated with once-monthly paliperidone palmitate vs. oral atypical antipsychotics [published online January 23, 2018]. Drugs Real World Outcomes. doi:10.1007/s40801-018-0130-4