Risk of Subsequent Relapses and Corresponding Healthcare Costs Among Recently-Relapsed Medicaid Patients With Schizophrenia

BACKGROUND: Schizophrenia relapses can cause a significant increase in healthcare resource utilization and costs. However, the risk of relapse may be different between patients initiated on once-monthly paliperidone palmitate (PP1M) or oral atypical antipsychotics (OAA) following a recent relapse.

METHODS: Multi-state Medicaid data (01/2009-03/2018) were used to identify adults with schizophrenia initiated on PP1M or OAA (index date) within 30 days following a schizophrenia-related relapse (defined as a schizophrenia-related inpatient or emergency room [ER] visit). Patients were additionally required to have 12 months of continuous eligibility before (baseline) and after (observation) the index date. Differences in baseline characteristics between PP1M and OAA patients were accounted for using 1:3 propensity score matching.

RESULTS: After matching, characteristics were well-balanced between PP1M (N=208, mean age=39 years, 35.6% female) and OAA patients (N=624, mean age=40 years, 34.9% female). Relative to the OAA cohort, PP1M patients were 68% (P < 0.001) less likely to have a subsequent relapse during the 12-month observation period. PP1M patients also had 36% (P=0.004) fewer all-cause inpatient admissions and 23% (P=0.048) fewer ER visits. The reduction in schizophrenia-related relapses, inpatient admissions, and ER visits for PP1M patients offset the $4,826 per patient per year (PPPY; P < 0.001) increase in pharmacy costs, resulting in a numerical, but not statistically significant, decrease in total healthcare costs of $673 PPPY (P=0.870) relative to OAA patients.

CONCLUSIONS: PP1M offers a clinical value with reduced subsequent relapses while remaining a cost-effective therapeutic option for patients with a recent schizophrenia relapse.

This poster was presented at the 32nd annual Psych Congress, held Oct. 3-6, 2019, in San Diego, California.