Transitioning from oral risperidone or paliperidone to once-monthly paliperidone palmitate: a real-world analysis among Veterans Health Administration patients with schizophrenia who have had at least one prior hospitalization
Transitioning from oral risperidone or paliperidone to once-monthly paliperidone palmitate: a real-world analysis among Veterans Health Administration patients with schizophrenia who have had at least one prior hospitalization
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DOI：
10.1080/03007995.2019.1651129
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发表时间：
2019-08-21
影响因子：
2.3
通讯作者：
Bashyal, Richa
中科院分区：
文献类型：
--
作者：
El Khoury, Antoine;Patel, Charmi;Bashyal, Richa
目的：通过比较受精神分裂症影响的退伍军人健康管理局(VHA)患者从口服利培酮或帕利培酮(口服RIS/PALI)到每月一次的帕利培酮棕榈酸酯(PP1M)的治疗模式、HrU和费用在转换为PP1M前后12个月的治疗模式、HrU和成本，以解决在现实世界中从口服利培酮或帕利培酮(口服RIS/PALI)过渡到PP1M的既往住院精神分裂症患者的医疗资源利用(Hru)和费用方面的空白。方法：从VHA数据库中纳入VHA精神分裂症患者(年龄18岁)，开始口服RIS/PALI，有1次全因住院，从2015年1月至2017年3月过渡到PP1M。第一个向PP1M过渡的日期被确定为索引日期。患者被要求在PP1M前和PP1M后12个月内具有连续健康计划资格。结果用Wilcoxon符号秩法和McNemar‘s检验进行适当的比较。结果：这项研究包括319名患者(平均年龄51.6[4.2]岁)，在基线和随访的12个月期间。在PP1M过渡前，7.2%的患者对口腔RIS/PALI有依从性(覆盖天数比例=80%)。PP1M过渡后，27.6%的患者坚持PP1M。PP1M转变前后HRU结果的比较显示，全因住院患者显著减少(3.5vs1.4，p<；0.0001)，住院时间缩短(43.4vs18.3天，p<；.0001)。精神健康和精神分裂症相关的Hru也出现了类似的趋势。成本结果比较显示，全原因住院成本(64,702美元比24,147美元，P<；.0001)、总医疗成本(87,917美元比56,947美元，P<；.0001)和总成本(91,181美元比69,106美元，P<；.0001)显著降低。精神健康和精神分裂症相关费用也出现了类似的趋势。结论：从口服RIS/PALI到PP1M的转变可能显著改善HrU，并为既往住院且<gt；=1的VHA患者提供潜在的成本节约。
Objective: To address gaps in the literature on healthcare resource utilization (HRU) and costs among patients with schizophrenia and prior hospitalization who transition from oral risperidone or paliperidone (oral ris/pali) to once-monthly paliperidone palmitate (PP1M) in a real-world setting by comparing treatment patterns, HRU, and costs 12-months pre- and post-transition to PP1M among Veterans Health Administration (VHA) patients affected by schizophrenia who have had >= 1 hospitalization. Methods: VHA patients with schizophrenia (aged >= 18 years) who initiated oral ris/pali, had >= 1 all-cause inpatient stay, and transitioned to PP1M from January 2015-March 2017 were included from the VHA database. The first transition date to PP1M was identified as the index date. Patients were required to have continuous health plan eligibility for 12 months pre- and post-PP1M. Outcomes were compared using the Wilcoxon signed-rank and McNemar's test, as appropriate. Results: The study included 319 patients (mean [SD] age = 51.6 [4.2] years) during 12 months of baseline and follow-up. During pre-PP1M transition, 7.2% of the patients were adherent (proportion of days covered [PDC] >= 80%) to oral ris/pali. Post-PP1M transition, 27.6% of the patients were adherent to PP1M. Comparison of HRU outcomes from the pre- to post-PP1M transition revealed significantly lower all-cause inpatient stays (3.5 vs 1.4, p < .0001) and shorter inpatient length of stay (43.4 vs 18.3 days, p < .0001). Similar trends were seen for mental health and schizophrenia-related HRU. Cost outcome comparison indicated significantly lower all-cause inpatient costs ($64,702 vs $24,147, p < .0001), total medical costs ($87,917 vs $56,947, p < .0001), and total costs ($91,181 vs $69,106, p < .0001). A similar trend was observed for mental health and schizophrenia-related costs. Conclusions: Transitioning from oral ris/pali to PP1M may significantly improve HRU and provide potential cost savings in VHA patients with schizophrenia and >= 1 prior hospitalization.