Substantial cost savings and fewer relapses resulted when patients with schizophrenia switched from oral atypical antipsychotics to paliperidone palmitate administered monthly with subsequent transitions. Researchers presented their findings at AMCP 2022.

“Among patients with schizophrenia, nonadherence to oral atypical antipsychotics leads to increased risk of relapses, entailing substantial economic burden,” authors noted.

Researchers created a 36-month Markov model to evaluate Medicaid cost savings among 2 nonadherent populations: patients with recent relapses, and patients 18-35 years of age regardless of prior relapses. Patients with schizophrenia switched from treatment with oral atypical antipsychotics to once-monthly paliperidone palmitate (PP1M), subsequently transitioned to once-every-3-months (PP3M) and once-every-6-months (PP6M).

“Patients were assumed nonadherent to oral atypical antipsychotics until switching, which was possible multiple times…Relapse rates were assumed consistent across treatments based on patients’ adherence,” authors noted.

Of a hypothetical health plan with 1 million members, 10,053 members were included, comprised of 7454 patients who recently relapsed and 4002 patients 18-35 years of age.

Switching 5% of nonadherent patients with recent relapses from oral atypical antipsychotics to PP1M with transitions to PP3M resulted in the following cost savings:

• $9279 per patient switched and $.29 per member per month in year 1;
• $8433 per patient switched and $.26 per member per month in year 2; and
• $6948 per patient switched and $.22 per member per month in year 3.

Additionally, across each respective year, 231, 197, and 162 relapses were avoided, corresponding to savings of $3.5 million, $3.1 million, and $2.6 million.

Adding transitions to PP6M resulted in per-patient-switched savings of $8835, $6364, and $4415 in years 1, 2, and 3, respectively, as well as 41 avoided relapses at year 3.

Switching 5% of patients 18-35 years of age from oral atypical antipsychotics to PP1M with transitions to PP3M resulted in savings of:

• $3660 per patient switched in year 1;
• $4082 per patient switched in year 2; and
• $3679 per patient switched in year 3.

After 3 years, this intervention also resulted in 205 avoided relapses and an associated $2.3 million in savings.

Adding transitions to PP6M for this group of patients incurred per-patient-switched savings of $3025 and $1140 in years 1 and 2, with incremental costs of $49 per patient switched in year 3. Eighteen relapses were avoided at year 3.

“Switching nonadherent recently relapsed and young adult patients with schizophrenia from oral atypical antipsychotics to PP1M, with transitions to PP3M, results in substantial cost savings and reduced relapse rates,” researchers concluded. “Incorporating transitions to PP6M leads to incremental costs yet a further reduction in relapse rates due to projected improved adherence and lower treatment discounts.”

Reference:
Morrison L, Lin D, Pilon D, et al. Projecting the economic outcomes of switching patients with schizophrenia from oral atypical antipsychotics to once-monthly, once-every-3-months, and once-every-6-months paliperidone palmitate. Poster presented at: AMCP 2022; March 29-April 1, 2022; Chicago, IL.