title: Impact of Paliperidone Palmitate Versus Oral Atypical Antipsychotics on Health Care Resource Use and Costs in Veterans with Schizophrenia.
abstract: OBJECTIVE
  To compare health care resource utilization and costs in veterans with schizophrenia treated with paliperidone palmitate (PP) versus oral atypical antipsychotics (OAAs).
  
  
  METHODS
  A retrospective longitudinal study was conducted using electronic health record data from the Veterans Health Administration. Veterans with schizophrenia (identified using ICD-9-CM 295.x) initiating PP or OAAs between January 2010 and October 2014, with ≥ 12 months of benefits enrollment prior to treatment initiation and ≥ 6 months of enrollment after treatment initiation, and with ≥ 1 Global Assessment of Functioning measurement at baseline were included. Inverse probability of treatment weighted regression models were used to estimate incidence rate ratios (IRRs) and cost differences (CDs) for the impact of PP versus OAAs on health care resource utilization and costs.
  
  
  RESULTS
  Among 10,290 eligible veterans, 2,285 and 8,005 were initiated on PP and OAAs, respectively. After adjustment, PP was associated with less frequent all-cause inpatient hospitalizations (IRR = 0.89, P < .001) and more frequent mental health intensive case management visits (IRR = 1.81, P < .001) compared to OAAs. PP treatment was associated with higher likelihood of increased income (odds ratio [OR] = 1.20, P = .027) and lower likelihood of homelessness (OR = 0.82, P < .001). While mean annual pharmacy and outpatient costs were higher among PP users (CD = $3,417 pharmacy, $2,527 outpatient, P < .001), mean annual inpatient costs were lower (CD = -$14,456, P < .001), resulting in average annual total health care (medical and pharmacy) cost savings associated with PP (CD = -$8,511, P = .012) relative to OAAs.
  
  
  CONCLUSIONS
  PP treatment was associated with significantly lower total health care costs attributable to reduced inpatient admissions compared to OAAs. Higher mental health intensive case management participation among PP users may have contributed to the differences observed.
authors: VA Medical Center, White River Junction, Vermont, USA.
authors: Yinong
authors: Y
authors: Young-Xu
authors: Analysis Group, Inc, Boston, Massachusetts, USA.
authors: Mei Sheng
authors: MS
authors: Duh
authors: Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Rd, Titusville, NJ 08560. emuser@its.jnj.com.|Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA.
authors: Erik
authors: E
authors: Muser
authors: Analysis Group, Inc, Boston, Massachusetts, USA.
authors: Maral
authors: M
authors: DerSarkissian
authors: Analysis Group, Inc, Boston, Massachusetts, USA.
authors: Elizabeth
authors: E
authors: Faust
authors: Analysis Group, Inc, Boston, Massachusetts, USA.
authors: Andrew
authors: A
authors: Kageleiry
authors: Analysis Group, Inc, Boston, Massachusetts, USA.
authors: Rachel H
authors: RH
authors: Bhak
authors: Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA.
authors: Dong-Jing
authors: DJ
authors: Fu
authors: Analysis Group, Inc, Boston, Massachusetts, USA.
authors: Patrick
authors: P
authors: Lefebvre
authors: VA Medical Center, White River Junction, Vermont, USA.
authors: Brian
authors: B
authors: Shiner
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D019090:Case Management / Q000191:economics / Q000706:statistics & numerical data; D015331:Cohort Studies; D003692:Delayed-Action Preparations; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007273:Injections, Intramuscular; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D000068882:Paliperidone Palmitate / Q000627:therapeutic use*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D012559:Schizophrenia / Q000188:drug therapy* / Q000191:economics*; D012565:Schizophrenic Psychology; D014728:Veterans / Q000523:psychology*
chemical_list: D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations; D000068882:Paliperidone Palmitate