title: Health Care Utilization and Treatment Persistence Associated with Oral Paliperidone and Lurasidone in Schizophrenia Treatment.
abstract: BACKGROUND
  Oral paliperidone and lurasidone are new second-generation antipsychotics (SGAs). Empirical evidence on the comparative costs and persistence of these 2 agents are absent in the literature.
  
  
  OBJECTIVE
  To assess health care use and persistence associated with the 2 new agents oral paliperidone and lurasidone and other SGAs.
  
  
  METHODS
  Schizophrenia patients who initiated SGA therapy were identified in the January 2007-June 2013 claims databases of a large managed care organization. Multivariate regressions using aripiprazole as the comparator were conducted. Ordinary least squares regressions were used to estimate the total medical and pharmacy costs associated with each drug. Poisson regressions were conducted to evaluate the frequency of hospitalizations and emergency department (ED) visits associated with each drug. A censored regression model was used to evaluate the comparative persistence. Sensitivity analyses using generalized linear models, two-part models, hurdle models, and instrumental variable regressions were also performed.
  
  
  RESULTS
  Compared with aripiprazole, paliperidone was not associated with significantly different total costs, yet lurasidone was associated with lower total costs (-$7,052; 95% CI = -$9,221, -$4,882). Lurasidone was also associated with significantly lower medical services costs (-$5,025; 95% CI = -$7,096, -$2,955), drug costs (-$2,026; 95% CI = -$2,695, -$1,357), hospital costs (-$3,026; 95% CI = -$4,731, -$1,321), outpatient costs (-$1,999; 95% CI = -$2,536, -$1,463), and ED costs (-$2,284; 95% CI = -$3,069, -$1,499), whereas paliperidone did not have significant effects on any types of costs. Paliperidone users had fewer ED visits (-0.25; 95% CI = -0.42, -0.08), while lurasidone users had fewer hospitalizations (-5.98; 95% CI = -6.61, -5.35) and fewer ED visits (-2.51; 95% CI = -2.92, -2.10). Both paliperidone and lurasidone were associated with lower levels of treatment persistence.
  
  
  CONCLUSIONS
  Paliperidone does not associate with lower total costs compared with commonly used SGAs, whereas lurasidone is associated with lower total health costs. Thus, high access fees of lurasidone are not necessarily a major concern in prescription.
authors: University of Southern California, USC Schaeffer Center, Verna Peter Dauterive Hall (VPD), 635 Downey Way, Los Angeles, CA 90089-3333. yawenjia@usc.edu.
authors: Yawen
authors: Y
authors: Jiang
authors: Weiyi
authors: W
authors: Ni
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D000068180:Aripiprazole / Q000008:administration & dosage / Q000191:economics; D015331:Cohort Studies; D016527:Drug Costs; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D000069056:Lurasidone Hydrochloride / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D000068882:Paliperidone Palmitate / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D010342:Patient Acceptance of Health Care; D012189:Retrospective Studies; D012559:Schizophrenia / Q000188:drug therapy* / Q000191:economics
chemical_list: D014150:Antipsychotic Agents; D000068180:Aripiprazole; D000069056:Lurasidone Hydrochloride; D000068882:Paliperidone Palmitate