title: Healthcare utilization and costs of Veterans Health Administration patients with schizophrenia treated with paliperidone palmitate long-acting injection or oral atypical antipsychotics.
abstract: OBJECTIVE
  This study aimed to compare real world healthcare costs and resource utilization between patients with schizophrenia treated with paliperidone palmitate long-acting injection (PP) and oral atypical antipsychotics (OAT).
  
  
  METHODS
  Patients (18-64 years) were selected from the Veterans Health Administration dataset (1 July 2007-31 May 2012). Patients with 2+ claims for PP or 2+ claims for the same OAT comprised the two study cohorts with the first prescription date designated as the index date. Participation in the VA healthcare system for 24 months pre- and 12 months post-index, schizophrenia diagnosis (International Classification of Disease 9th Revision Clinical Modification [ICD-9-CM] code 295.1x-6x, 295.8x-9x) and ≥1 claim for an antipsychotic medication during the baseline period were required. Propensity scores and Mahalanobis metric distances with calipers were used to create two matched cohorts. All-cause healthcare utilization and costs for the 12-month follow-up period were compared between matched cohorts.
  
  
  RESULTS
  The matching process produced two cohorts of 335 patients with similar baseline characteristics. During the 12-month follow-up period, patients in the PP cohort had lower mean inpatient costs (18,560 vs $31,505, p = 0.002), lower frequency of hospitalization (34% vs 53%, p < 0.001) and fewer average inpatient days (13.24 vs 24.18, p = 0.002) vs matched OAT patients. While mean pharmacy costs were higher for the PP cohort ($10,063 vs $4167, p < 0.001), mean total healthcare costs were not significantly different ($45,529 vs $52,569, p = 0.128).
  
  
  CONCLUSIONS
  VA patients, diagnosed with schizophrenia and treated with PP, had lower inpatient costs and admission rates compared to a matched cohort of OAT patients. Total healthcare costs were not significantly different.
authors.affiliation: STATinMED , Ann Arbor, MI , USA.
authors.forename: Onur
authors.initials: O
authors.lastname: Baser
authors.forename: Lin
authors.initials: L
authors.lastname: Xie
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Pesa
authors.forename: Mike
authors.initials: M
authors.lastname: Durkin
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000191:economics* / Q000627:therapeutic use; D015897:Comorbidity; D003692:Delayed-Action Preparations; D004359:Drug Therapy, Combination; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000068882:Paliperidone Palmitate / Q000191:economics* / Q000627:therapeutic use; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D057216:Propensity Score; D012189:Retrospective Studies; D012559:Schizophrenia / Q000188:drug therapy*; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations; D000068882:Paliperidone Palmitate
keywords: Healthcare cost; Hospitalization; Long-acting antipsychotics; Oral atypical antipsychotics; Paliperidone palmitate; Schizophrenia