The Impact of Once-Monthly Paliperidone Palmitate on Healthcare Utilization Among Patients With Schizophrenia Treated in an Integrated Healthcare System

Objective: A previous study demonstrated that patients with schizophrenia consumed substantial healthcare resources in an integrated healthcare system. This study evaluated healthcare utilization before and after initiation of once-monthly paliperidone palmitate (PP1M) among patients with schizophrenia treated in a US integrated healthcare system.

Methods: This retrospective study used Atrium Health’s electronic medical records. Adults with ≥ 2 diagnoses for schizophrenia who received an initial PP1M dose (the corresponding date defined the index date) and a subsequent dose within 90 days between 09/2009 – 04/2019 were included. Additionally, patients were required to receive active care (≥1 healthcare visit every 6 months) during 12-month pre- and post-index and ≥1 oral antipsychotic prescription during 12-month pre-index. Inpatient, emergency room (ER) and outpatient visits (mean number of visits and percentage of patients with visits) were compared over 12-month pre- versus post-index within the same cohort using McNemar’s and Wilcoxon signed rank tests.

Results: The study cohort included 210 patients (mean age = 34.2 years, 69.5% male, 73.8% black, 62.9% with Medicare/Medicaid). The percentage of patients with visits and mean number of visits reduced for all-cause inpatient (67.6% to 22.4%, 1.2 to 0.4), 30-day readmission (12.4% to 2.4%, 0.2 to 0.1), and ER (68.6% to 45.7%, 2.3 to 1.2) visits, whereas the mean number of outpatient visits increased (8.7 to 11.6) from pre- to post-index (all p < 0.05). Similar trends were observed for mental health- and schizophrenia-related healthcare utilization.

Conclusion: Initiation of PP1M was associated with reduced acute healthcare utilization in patients with schizophrenia.