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Zhou Y, Chen B, Huang Y. Healthcare utilization and economics evaluation of paliperidone palmitate once-monthly in schizophrenia: a one-year, real-world, and retrospective mirror image study in China. Front Psychiatry 2024; 15:1415275. [PMID: 39296858 PMCID: PMC11408208 DOI: 10.3389/fpsyt.2024.1415275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 08/20/2024] [Indexed: 09/21/2024] Open
Abstract
Background Investigation and analysis of the changes in healthcare resources and burden of schizophrenia in the real world before and after switching from oral antipsychotics (OAPs) to paliperidone palmitate once-monthly (PP1M) could provide evidence to clinicians and patients for choosing treatment modality and data support for health policy optimization. Methods The first dosage of PP1M was set as mirror point, and patients with mirror point between January 2020 and June 2022 were recruited in the study. The differences in treatment patterns, healthcare resource utilization, and costs within one year before and after the mirror point were compared. Results A total of 72 patients transitioning from OAPs to PP1M (mean age, 35.33 years; 43.06% female) were included in the study. Of the 72 patients, the application of PP1M resulted in a significant reduction in the hospitalization times, emergency room visits, and direct medical costs (P < 0.001), while the pharmacy cost and total cost increased by 222.57% (P < 0.001) and 16.35% (P < 0.001), respectively; PP1M accounted for 88.48% of the pharmacy cost. For patients with ≥1 hospitalization during the OAPs phase (n = 25), the number of hospitalizations, hospitalization days and hospitalization expenses decreased by more than 90% (P < 0.001). Total one-year expenses decreased by 37.67% (P < 0.001), and pharmacy expenses increased by 185.21% (P < 0.001). For patients with no hospitalizations during the OAPs phase (n = 47), emergency and outpatient visits decreased by 70% (P < 0.001) and 30.27% (P < 0.05), respectively, while the total cost increased by 117.56% (P < 0.001), and the pharmacy cost increased by 260.15% (P < 0.001) after initiation of PP1M treatment. Conclusion After the transition to PP1M, the number of hospitalizations and outpatient and emergency department visits reduced, and healthcare resources were conserved. Switching to PP1M may be more economically beneficial for patients with prior hospitalizations while on OAP regimens. The high price of PP1M might be an obstacle to its widespread use.
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Affiliation(s)
- Yixiang Zhou
- Department of Pharmacy, Xiamen Xianyue Hospital, Xiamen, China
- Xianyue Hospital Affiliated with Xiamen Medical College, Xiamen, China
- Fujian Psychiatric Center, Xiamen, China
- Fujian Clinical Research Center for Mental Disorders, Xiamen, China
| | - Binbin Chen
- Xianyue Hospital Affiliated with Xiamen Medical College, Xiamen, China
- Fujian Psychiatric Center, Xiamen, China
- Fujian Clinical Research Center for Mental Disorders, Xiamen, China
- Department of Clinical Pharmacy, Xiamen Xianyue Hospital, Xiamen, China
| | - Yinghua Huang
- Department of Pharmacy, Xiamen Xianyue Hospital, Xiamen, China
- Xianyue Hospital Affiliated with Xiamen Medical College, Xiamen, China
- Fujian Psychiatric Center, Xiamen, China
- Fujian Clinical Research Center for Mental Disorders, Xiamen, China
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Wang GHM, Svensson M, Shao H, Vouri SM, Park H. Cost-effectiveness analysis of monthly, 3-monthly, and 6-monthly long-acting injectable and oral paliperidone in adults with schizophrenia. J Manag Care Spec Pharm 2023; 29:884-895. [PMID: 37523313 PMCID: PMC10397333 DOI: 10.18553/jmcp.2023.29.8.884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
BACKGROUND: Paliperidone is among the most cost-effective antipsychotics in adults with schizophrenia, and it has different formulations, including oral paliperidone extended-release (ER) and long-acting injectable (LAI) paliperidone formulations administered every month (PP1M), 3 months (PP3M), or 6 months (PP6M). However, cost-effectiveness analyses comparing different paliperidone formulations were limited. OBJECTIVE: To compare the cost-effectiveness across different paliperidone formulations. METHODS: A Markov model was developed to simulate 1,000 adults aged 40 years with stable schizophrenia transitioning among stable disease-medication adherent, stable disease-medication nonadherent, relapse with hospitalization, relapse with ambulatory care, and death states every 3 months for 5 years. Drug costs were estimated using the prices listed in the Veterans Affairs Federal Supply Schedule, and costs for treating complications were estimated from published studies. All costs were estimated from the US health care system perspective and standardized to 2022 US dollars using the Consumer Price Index Inflation Calculator. Quality-adjusted life-years (QALYs) were estimated using relapse rates from randomized clinical trials and health-related quality of life scores from observational studies. The estimated future costs and QALYs were discounted at 3%. We reported incremental net monetary benefits between alternative formulations at the $50,000 willingness-to-pay (WTP) threshold with a positive value indicating cost-effectiveness. The impact of parameter uncertainty on study outcomes was assessed using 1-way deterministic and probabilistic sensitivity analyses. RESULTS: In adults with schizophrenia stabilized with paliperidone ER, switching to LAI formulations was associated with increased QALY (PP1M = 0.05, PP3M = 0.14, PP6M = 0.15) and increased cost (PP1M = 49,433, PP3M = 26,698, PP6M = 26,147), leading to a negative incremental net monetary benefit (PP1M = -$46,804, PP3M = -$19,508, PP6M = -$18,886) compared with continuing ER. Among LAI formulations, PP6M was cost-saving with the most QALYs gained (cost = $63,277, QALY = 3.731), followed by PP3M (cost = $63,828, QALY = 3.729) and PP1M (cost = $86,563, QALY = 3.638). At the $50,000 WTP threshold, the probabilities for PP1M, PP3M, and PP6M being cost-effective compared with paliperidone ER were 0.4%, 10.2%, and 9.8%, respectively. The probability of PP6M being cost-effective was 92.6% for the PP6M-PP1M pair and 55.2% for the PP6M-PP3M pair, and 91.1% of PP3M use was cost-effective in the PP3M-PP1M pair. The results were generally robust in the sensitivity analyses, even at the $190,000 WTP threshold. CONCLUSIONS: For patients with schizophrenia stabilized with paliperidone ER, switching to LAI formulations was not cost-effective, suggesting the high drug costs for LAI may not justify the improved quality of life within 5 years. Among LAI formulations, PP6M was cost-effective over PP1M and PP3M.
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Affiliation(s)
- Grace Hsin-Min Wang
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville
| | - Mikael Svensson
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville
| | - Hui Shao
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville
| | - Scott Martin Vouri
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville
- Center for Drug Evaluation and Safety, College of Pharmacy, University of Florida, Gainesville
| | - Haesuk Park
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville
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Rosenheck R, Anand ST, Kurtz SG, Hau C, Smedberg D, Pontzer JF, Ferguson RE, Davis CR. Can multisite clinical trial results change clinical practice? Use of long-acting injectable risperidone nationally in the Veterans Health Administration. Trials 2023; 24:85. [PMID: 36747254 PMCID: PMC9900548 DOI: 10.1186/s13063-023-07094-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/12/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Multisite practical clinical trials evaluate treatments in real-world practice. A multisite randomized Veterans Health Administration (VHA) cooperative study (CSP#555) published in 2011 compared the first long-acting injectable (LAI) second-generation antipsychotic (SGA), Risperidone Consta®, in veterans with a diagnosis of schizophrenia or schizoaffective disorder, to oral antipsychotics, with unexpected null results for effectiveness and cost-effectiveness. Whether null results of this type could change VHA practice has not been studied. METHODS A longitudinal observational analysis was used to evaluate the impact of the trial findings on VHA clinical practices. National administrative data compared new starts on LAI risperidone during the 4 years before the publication of CSP#555 in 2011 to new starts on LAI risperidone during the 4 years after. RESULTS Among 119,565 Veterans with the indicated diagnoses treated with antipsychotics from 2007 to 2015, the number and proportion of new starts on LAI risperidone declined significantly following the study publication, as did the total number of annual users and drug expenditures. However, data from 2007 to 2010 showed the decline in new starts actually preceded the publication of CSP#555. This change was likely explained by the increase in new starts, total use, and expenditures on a newer medicine, LAI paliperidone, a 4-week LAI treatment, in the 2 years prior to the publication of CSP#555. CONCLUSIONS The declining use of LAI risperidone likely primarily reflects the substitution of a longer-acting LAI SGA, paliperidone, that came to market 2 years before the study publication, a substitution that may have been reinforced by null CSP#555 study results for LAI risperidone.
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Affiliation(s)
- Robert Rosenheck
- VA New England Mental Illness, Research, Education and Clinical Center, 151D, 950 Campbell Ave., West Haven, CT, 06516, USA.
- Department of Psychiatry, Yale Medical School, West Haven, CT, USA.
| | - Sonia T Anand
- VA Cooperative Studies Program Coordinating Center, Boston, MA, USA
| | - Stephen G Kurtz
- VA Cooperative Studies Program Coordinating Center, Boston, MA, USA
| | - Cynthia Hau
- VA Cooperative Studies Program Coordinating Center, Boston, MA, USA
| | - Diane Smedberg
- VA Cooperative Studies Program Coordinating Center, Boston, MA, USA
| | - James F Pontzer
- VA Clinical Research Pharmacy Coordinating Center, Albuquerque, NM, USA
- VA Office of Research and Development, Cooperative Studies Program, Albuquerque, NM, USA
| | - Ryan E Ferguson
- VA Cooperative Studies Program Coordinating Center, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
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Lin D, Thompson-Leduc P, Ghelerter I, Nguyen H, Lafeuille MH, Benson C, Mavros P, Lefebvre P. Real-World Evidence of the Clinical and Economic Impact of Long-Acting Injectable Versus Oral Antipsychotics Among Patients with Schizophrenia in the United States: A Systematic Review and Meta-Analysis. CNS Drugs 2021; 35:469-481. [PMID: 33909272 PMCID: PMC8144083 DOI: 10.1007/s40263-021-00815-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Long-acting injectable (LAI) antipsychotics, compared with oral antipsychotics (OA), have been found to significantly improve patient outcomes, including reduced hospitalizations and emergency room (ER) admissions and increased medication adherence among adult patients with schizophrenia. In turn, the clinical benefits achieved may translate into lower economic burden. Real-world evidence of the comparative effectiveness of LAI is needed to understand the potential benefits of LAI outside of the context of clinical trials. This study aimed to provide a comprehensive synthesis of recent published real-world studies comparing healthcare utilization, costs, and adherence between patients with schizophrenia treated with LAI versus OA in the United States. METHODS In this systematic literature review, MEDLINE® was searched for peer-reviewed, real-world studies (i.e., retrospective or pragmatic designs) published in English between January 1, 2010 and February 10, 2020. Comparative studies reporting hospitalizations, ER admissions, healthcare costs, or medication adherence (measured by proportion of days covered [PDC]) in adults with schizophrenia treated with LAI versus OA (or pre- vs post-LAI initiation) in the United States were retained. Random effects meta-analyses were conducted among eligible studies to evaluate the association of LAI versus OA use on hospitalizations, ER admissions, healthcare costs, and treatment adherence. A sensitivity analysis among the subset of studies that compared OA with paliperidone palmitate once monthly (PP1M), specifically, was conducted. RESULTS A total of 1083 articles were identified by the electronic literature search, and two publications were manually added subsequently. Among the 57 publications meeting the inclusion criteria, 25 provided sufficient information for inclusion in the meta-analyses. Compared with patients treated with OA, patients initiated on LAI had lower odds of hospitalization (odds ratio [OR] 0.62, 95% confidence interval [CI] 0.54-0.71, n = 7), fewer hospitalizations (incidence rate ratio [IRR] [95% CI] 0.75 [0.65-0.88], n = 9), and fewer ER admissions (IRR [95% CI] 0.86 [0.77-0.97], n = 6). The initiation of LAI was associated with higher per-patient-per-year (PPPY) pharmacy costs (mean difference [MD] [95% CI] $5603 [3799-7407], n = 6), which was offset by lower PPPY medical costs (MD [95% CI] - $5404 [- 7745 to - 3064], n = 6), resulting in no significant net difference in PPPY total all-cause healthcare costs between patients treated with LAI and those treated with OA (MD [95% CI] $327 [- 1565 to 2219], n = 7). Patients initiated on LAI also had higher odds of being adherent to their medication (PDC ≥ 80%; OR [95% CI] 1.89 [1.52-2.35], n = 9). A sensitivity analysis on a subset of publications evaluating PP1M found results similar to those of the main analysis conducted at the LAI class level. CONCLUSIONS Based on multiple studies with varying sub-types of patient populations with schizophrenia in the United States published in the last decade, this meta-analysis demonstrated that LAI antipsychotics were associated with improved medication adherence and significant clinical benefit such as reduced hospitalizations and ER admissions compared with OA. The lower medical costs offset the higher pharmacy costs, resulting in a non-significant difference in total healthcare costs. Taken together, these findings provide strong evidence on the clinical and economic benefits of LAI compared with OA for the treatment of schizophrenia in the real world.
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Affiliation(s)
- Dee Lin
- Janssen Scientific Affairs, LLC, Titusville, NJ USA
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Berna F, Göritz AS, Behr G, Moritz S. Pill or needle? Determinants of the preference for long-acting injection over oral treatment in people facing chronic illness. Prog Neuropsychopharmacol Biol Psychiatry 2020; 98:109798. [PMID: 31682893 DOI: 10.1016/j.pnpbp.2019.109798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 10/17/2019] [Accepted: 10/24/2019] [Indexed: 10/25/2022]
Abstract
Although long-acting injection (LAI) is presented as first line treatment option for patients with psychosis, negative attitudes toward this galenic negatively impact the selection of this treatment option. However, these negative attitudes may not be confined to patients but also observed in the general population. A web-based study on 1807 participants was conducted during which participants imagined that they had a particular chronic illness based on clinical vignettes (mental illnesses: schizophrenia, depression; somatic illnesses: multiple sclerosis, rheumatoid arthritis). The frequency of relapse and the intensity of symptoms were experimentally manipulated in the vignettes. Participants rated their subjective distress associated with each vignette, their belief in the effectiveness of treatment, and their treatment preference regarding medication. We examined under which conditions LAI was preferred over pills. Statistical analyses were performed using Bayesian methods. Results showed that participants preferred LAI over pills in 40.5% to 50.8% of cases. LAI was more preferred for illnesses with low frequency of relapse, low subjective distress, and for somatic than for mental illnesses. The perceived advantage for LAI over pills and the belief about the better efficiency of LAI were the main factors that drove the preference for LAI. Keeping in mind some advantages of LAI, the public negative representations of injections might partially influence patients' prejudices against LAI. These attitudes should be named and discussed with the patients when LAI seems to represent a relevant therapeutic option.
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Affiliation(s)
- Fabrice Berna
- Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Inserm U1114, Strasbourg, France; Fondation FondaMental, Créteil, France.
| | - Anja S Göritz
- Occupational and Consumer Psychology, Freiburg University, Freiburg, Germany.
| | - Guillaume Behr
- Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Inserm U1114, Strasbourg, France.
| | - Steffen Moritz
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistr. 52, D-20246 Hamburg, Germany.
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Long-Acting Injectables Versus Oral Antipsychotics: A Retrospective Bidirectional Mirror-Image Study. J Clin Psychopharmacol 2020; 39:441-445. [PMID: 31415288 DOI: 10.1097/jcp.0000000000001082] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Mirror-image studies, which compare equal periods of time before and after a new treatment is introduced, may reflect the real-world impact of that treatment. However, most mirror-image studies that have investigated the impact of long-acting injectable antipsychotics (LAIs) were unidirectional in design, for patients switching from oral antipsychotics (OAPs) to LAIs. Therefore, we conducted a bidirectional mirror-image study comparing LAIs and OAPs. METHODS We included 126 schizophrenia or schizoaffective disorder patients' LAI treatment data from 3 psychiatric hospitals. Patients took OAPs for 6 months or more before initiating LAIs, or the reverse. We obtained data on the number of hospitalizations as a primary outcome, plus the total duration and mean duration of hospitalization as secondary outcomes during the 6 months of the patients' first treatment, and the 6 months after the patients started their second type of treatment. RESULTS The results indicated that there was no significant difference in any outcomes between LAI and OAP treatment when going from LAIs to OAPs (n = 59). However, when patients started with OAPs and switched to LAIs (n = 67), they were hospitalized a significantly fewer number of times, and the duration of their stays was shorter in the LAI phase than in the OAP phase. When combined with bidirectional data, LAI superiority was still observed. CONCLUSIONS The findings endorse the relative effectiveness of LAIs over OAPs in the real world, although the inherent flaws of mirror-image studies such as expectation bias and having no parallel comparator should be considered.
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Rhee TG, Rosenheck RA. Association of current and past opioid use disorders with health-related quality of life and employment among US adults. Drug Alcohol Depend 2019; 199:122-128. [PMID: 31039486 PMCID: PMC6538934 DOI: 10.1016/j.drugalcdep.2019.03.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/05/2019] [Accepted: 03/05/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND To examine the association of current and past Opiate Use Disorder (OUD) with measures of HRQOL and employment in a nationally representative sample of adults. METHODS The 2012-2013 National Epidemiological Survey on Alcohol and Related Conditions III (NESARC III) surveyed a nationally representative sample of non-institutionalized civilian adults (≥18 years) in the US (n = 36,309 unweighted). Using DSM-5 criteria, adults without history of OUD were compared to those with current and past OUD. Using the SF-12 items, standard measures of the mental and physical component scores of HRQOL and of quality-adjusted life years (QALYs) were constructed. Employment in the past year (yes/no) was also assessed. Multivariable-adjusted regression analyses were used to adjust for covariates. RESULTS Overall, 0.9% of the study sample, representing 2.1 of 235.4 million adults, met criteria for current OUD; 1.2%, representing 2.7 million adults, met criteria for past OUD. Adults with current or past OUD had large and moderately reduced mental component (MCS) and physical health component (PCS) summary scores compared to adults who never had OUD (p < 0.001, respectively). Current OUD was associated with lower odds of being employed compared to never experiencing OUD (Adjusted odds ratio = 0.65; 95% CI: 0.48, 0.88; p = 0.005), as was past OUD. Adjustment for potentially confounding factors reduced the independent association of OUD and HRQOL by about 40-50% but did not change employment comparisons. CONCLUSION Adults with current OUD are associated with large reductions in HRQOL and likelihood of not being employed, and adults with past OUD also have considerable residual impairment.
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Affiliation(s)
- Taeho Greg Rhee
- Department of Community Medicine and Health Care, School of Medicine, University of Connecticut, Farmington, CT, USA; Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA; New England Mental Illness, Research, Education, and Clinical Center (MIRECC), USA; Department of Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.
| | - Robert A Rosenheck
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA; New England Mental Illness, Research, Education, and Clinical Center (MIRECC), USA; Department of Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
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Aydın N, Aytaç HM, Yazıcı E, Yılmaz D, Çetinay Aydın P, Yüksel Yalçın G, Kadıoğlu Y, Canbay C, Terzioğlu M, Şenol O, Çakmak C, Özer A. Rediscovery of penicillin of psychiatry: haloperidol decanoate. PSYCHIAT CLIN PSYCH 2018. [DOI: 10.1080/24750573.2018.1533190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Nazan Aydın
- Department of Psychology, Humanities and Social Sciences Faculty, Üsküdar University, İstanbul, Turkey
| | - Hasan Mervan Aytaç
- Bakirkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Disease Education and Research Hospital, Istanbul, Turkey
| | - Esra Yazıcı
- Department of Psychiatry, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Doğan Yılmaz
- Van Training and Research Hospital, Department of Psychiatry, Bakirkoy Research & Training Hospital for Psychiatry, Neurology and Neurosurgery, Alcohol and Drug Research Treatment and Training Center (AMATEM), İstanbul, Turkey
| | - Pınar Çetinay Aydın
- Bakirkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Disease Education and Research Hospital, Istanbul, Turkey
| | | | - Yücel Kadıoğlu
- Department of Analytical Chemistry, Faculty of Pharmacy, Atatürk University, Erzurum, Turkey
| | - Cana Canbay
- Van Training and Research Hospital, Department of Psychiatry, Bakirkoy Research & Training Hospital for Psychiatry, Neurology and Neurosurgery, Alcohol and Drug Research Treatment and Training Center (AMATEM), İstanbul, Turkey
| | - Merve Terzioğlu
- Bakirkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Disease Education and Research Hospital, Istanbul, Turkey
| | - Onur Şenol
- Department of Analytical Chemistry, Faculty of Pharmacy, Atatürk University, Erzurum, Turkey
| | - Cavide Çakmak
- Bakirkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Disease Education and Research Hospital, Istanbul, Turkey
| | - Aysel Özer
- Bakirkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Disease Education and Research Hospital, Istanbul, Turkey
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Joshi K, Muser E, Xu Y, Schwab P, Datar M, Suehs B. Adherence and economic impact of paliperidone palmitate versus oral atypical antipsychotics in a Medicare population. J Comp Eff Res 2018; 7:723-735. [PMID: 29722547 DOI: 10.2217/cer-2018-0003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To compare adherence, healthcare utilization and costs among real world, Medicare-eligible patients with schizophrenia using long-acting injectable paliperidone palmitate (PP) versus oral atypical antipsychotics. Patients & methods: Historical cohort study used Medicare Advantage claims data. Inverse probability of treatment weighting was applied to adjust for baseline differences. 12-month adherence, healthcare utilization and costs were compared. Results: Patients using PP were more adherent (proportion of days covered ≥0.8; 48.1 vs 32.6%; p < 0.001), had lower odds of hospitalization (odds ratio [OR]: 0.81; 95% CI: 0.68-0.96) and lower medical costs ($11,095; 95% CI: $10,374-11,867 vs $15,551; 95% CI: $14,584-16,583), but higher pharmacy costs ($14,787; 95% CI: $14,117-15,488 vs $5781; 95% CI: $5530-6043). Conclusion: Compared with patients using oral atypical antipsychotics, PP had lower hospitalizations and medical costs with greater medication adherence accompanied by higher pharmacy costs.
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Affiliation(s)
- Kruti Joshi
- Janssen Scientific Affairs LLC, Titusville, NJ 08560 USA
| | - Erik Muser
- Janssen Scientific Affairs LLC, Titusville, NJ 08560 USA
| | - Yihua Xu
- Comprehensive Health Insights, Inc., Humana, Louisville, KY 40202 USA
| | - Phil Schwab
- Comprehensive Health Insights, Inc., Humana, Louisville, KY 40202 USA
| | - Manasi Datar
- Comprehensive Health Insights, Inc., Humana, Louisville, KY 40202 USA
| | - Brandon Suehs
- Comprehensive Health Insights, Inc., Humana, Louisville, KY 40202 USA
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Emsley R, Kilian S. Efficacy and safety profile of paliperidone palmitate injections in the management of patients with schizophrenia: an evidence-based review. Neuropsychiatr Dis Treat 2018; 14:205-223. [PMID: 29379293 PMCID: PMC5759847 DOI: 10.2147/ndt.s139633] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The course of schizophrenia is characterized by multiple relapses, incomplete remission of symptoms, enduring cognitive deficits, and social and occupational functional impairments. Nonadherence to antipsychotic medication is a major determinant of this poor outcome. Long-acting injectable antipsychotics were developed specifically to address the nonadherence problem and are increasingly considered as an early treatment option, in an attempt to prevent accruing morbidity. This review focuses on paliperidone palmitate, the long-acting injectable (LAI) formulation of paliperidone. After considering the pharmacology of paliperidone palmitate, we review the randomized controlled trials, as well as pertinent observational, pragmatic studies for paliperidone once-monthly injections in schizophrenia. Finally, we review the recently introduced 3-monthly formulation of paliperidone palmitate. Taken together, the studies indicate that paliperidone palmitate (PP) has good efficacy compared with placebo and comparable with other antipsychotics including risperidone. The tolerability profile of PP is similar to that of risperidone, with the most important side effects being prolactin elevation, weight gain, and extrapyramidal symptoms. Advantages of PP include the extensive research database and clinical experience with paliperidone and its parent compound risperidone, the availability of different LAI formulations (once-monthly, 3-monthly, and perhaps even longer acting formulations in future), and the novel dose initiation procedure that provides rapid onset of action without the need for oral antipsychotic supplementation.
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Affiliation(s)
- Robin Emsley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sanja Kilian
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Gentile S. Safety concerns associated with second-generation antipsychotic long-acting injection treatment. A systematic update. Horm Mol Biol Clin Investig 2017; 36:/j/hmbci.ahead-of-print/hmbci-2017-0004/hmbci-2017-0004.xml. [PMID: 28672735 DOI: 10.1515/hmbci-2017-0004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/08/2017] [Indexed: 11/15/2022]
Abstract
Background It has been recently suggested that second-generation antipsychotic long-acting injection (SGA-LAIs) are underutilized in clinical practice, despite that their costs significantly impact on national health system budgets. Hence, an updated analysis of safety data shown by SGA-LAIs may contribute to clarify their role in clinical practice. Materials and methods English-language, peer-reviewed articles reporting updated, primary findings on the SGA-LAI safety were identified (updated through an electronic search of five databases - PubMed, EMBASE, PsycInfo, DARE and the Cochrane Library). Results The articles reviewed suggest that the most frequent treatment emergent adverse events (TEAEs) associated with aripiprazole long-acting injection (ARI-LAI) are psychotic symptoms, extrapyramidal symptoms (EPS) and weight gain. Data on olanzapine long-acting injection (OLA-LAI)-associated TEAEs highlight the risk of psychosis, metabolic disturbances and hyperprolactinemia. Four-hundred and forty cases of post-injection delirium/sedation syndrome (PDSS) have also been recorded. Although not reported in reviewed studies, the risk of impulse-control problem and drug reaction with eosinophilia and systemic symptoms (DRESS) ARI- and OLA-associated, respectively, must not be underestimated. With regards paliperidone palmitate 1-month formulation (PP1), the high incidence of clinically relevant weight gain and hyperprolactinemia are both findings of concern. Reviewed data also confirm that the leading cause of death in risperidone long-acting injection (RIS-LAI) clinical trials is suicide. The new 3-month paliperidone palmitate formulation, risperidone sustained release 1-month formulation (RIS-SR1), aripiprazole lauroxil (ARI-LXL) are still lacking exhaustive safety data. Conclusion The risk of specific TEAEs associated with all SGA-LAIs confirms SGA-LAIs do not offer advantages in safety compared with FGA-LAIs or oral antipsychotics and, especially, in early-phase schizophrenia patients. Implementing non pharmacological intervention and strategies can be effective for people with schizophrenia and bipolar disorder who adhere poorly to medication regimens.
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Affiliation(s)
- Salvatore Gentile
- Department of Mental Health ASL Salerno, Piazza Galdi, 1 Cava de' Tirreni 84013, Salerno, Italy.,University of Naples, Medical School "Federico II", Department of Neurosciences, Psychiatry and Drug-resistance Unit, Perinatal Psychiatry, Via S. Pansini, 5 Naples 80131, Italy, Phone: +39 089 4455439, Fax: +39 089 4455440
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