Lefebvre Patrick, Muser Erik, Joshi Kruti, DerSarkissian Maral, Bhak Rachel H, Duh Mei Sheng, Shiner Brian, Young-Xu Yinong
Analysis Group, Inc, Boston, Massachussetts.
Janssen Scientific Affairs, LLC, Titusville, New Jersey.
Clin Ther. 2017 Jul;39(7):1380-1395.e4. doi: 10.1016/j.clinthera.2017.05.356. Epub 2017 Jun 20.
Almost half of all patients diagnosed with schizophrenia have a history of substance abuse (SA). However, data on treatment of schizophrenia with paliperidone palmitate (PP) among patients with comorbid SA are limited. The objective of this study was to compare all-cause and SA-related health care resource utilization and costs in veterans with schizophrenia and co-occurring SA who were treated with PP versus oral atypical antipsychotics (OAAs).
Veterans Health Administration electronic health record data were used to conduct a retrospective longitudinal study in veterans with schizophrenia who initiated PP or OAA between January 1, 2010 and June 30, 2016, had ≥12 months of enrollment before treatment initiation (baseline), were diagnosed with SA, and had ≥1 Global Assessment of Functioning score during baseline. Differences in baseline characteristics were adjusted for using inverse probability of treatment weighting. Adjusted cost differences and incidence rate ratios (IRR) for the association between PP versus OAA and all-cause and SA-related health care costs and health care resource utilization in the 12 months after treatment initiation were estimated with corresponding 95% CIs using weighted linear and Poisson regression models, respectively.
Of 6872 veterans in the study, 1684 (25%) and 5188 (75%) were treated with PP and OAA, respectively. After adjustment, PP was associated with fewer all-cause inpatient (IRR = 0.88; 95% CI, 0.85 to 0.90), mental health-related inpatient (IRR = 0.88; 95% CI, 0.85 to 0.91), and long-term care stays (IRR = 0.53; 95% CI, 0.44 to 0.64), but more frequent mental health intensive case management visits (IRR = 1.51; 95% CI, 1.49 to 1.53) compared with OAA (all P < 0.001). Similarly, PP was associated with significantly lower rates of SA-related inpatient stays (IRR = 0.80; 95% CI, 0.77 to 0.83), mental health stays (IRR = 0.85; 95% CI, 0.82 to 0.88), long-term care stays (IRR = 0.22; 95% CI, 0.15 to 0.32), and outpatient visits (IRR = 0.78; 95% CI, 0.77 to 0.79) than OAA (all P < 0.001). Relative to OAA, patients treated with PP also had lower mean annual all-cause (cost difference = -$10,473; 95% CI, -$17,827 to -$3491) and SA-related (cost difference = -$8457; 95% CI, -$12,710 to -$3638) medical costs (all P < 0.001).
PP was associated with significant total medical cost savings resulting from fewer hospitalizations and lower rates of SA-related health care resource utilization compared with OAA in patients with schizophrenia and comorbid SA. Thus, PP appears to be a valuable treatment option for patients in this subpopulation.
在所有被诊断为精神分裂症的患者中，近一半有药物滥用（SA）史。然而，关于合并SA的患者使用棕榈酸帕利哌酮（PP）治疗精神分裂症的数据有限。本研究的目的是比较接受PP治疗与口服非典型抗精神病药物（OAA）治疗的合并SA的精神分裂症退伍军人的全因和SA相关的医疗保健资源利用及成本。
利用退伍军人健康管理局的电子健康记录数据，对2010年1月1日至2016年6月30日期间开始使用PP或OAA、在治疗开始前有≥12个月的登记时间（基线）、被诊断为SA且在基线时有≥1次全球功能评估得分的精神分裂症退伍军人进行回顾性纵向研究。使用治疗权重的逆概率对基线特征的差异进行调整。使用加权线性回归模型和泊松回归模型分别估计PP与OAA之间关联的调整成本差异和发病率比（IRR），以及治疗开始后12个月内全因和SA相关的医疗保健成本及医疗保健资源利用情况，并给出相应的95%置信区间。
在该研究的6872名退伍军人中，分别有1684名（25%）和5188名（75%）接受了PP和OAA治疗。调整后，与OAA相比，PP与更少的全因住院（IRR = 0.88；95% CI，0.85至0.90）、心理健康相关住院（IRR = 0.88；95% CI，0.85至0.91）和长期护理住院（IRR = 0.53；95% CI，0.44至0.64）相关，但心理健康强化个案管理访视更频繁（IRR = 1.51；95% CI，1.49至1.53）（所有P < 0.001）。同样，与OAA相比，PP与SA相关住院率（IRR = 0.80；95% CI，0.77至0.83）、心理健康住院率（IRR = 0.85；95% CI，0.82至0.88）、长期护理住院率（IRR = 0.22；95% CI，0.15至0.32）和门诊就诊率（IRR = 0.78；95% CI，0.77至0.79）显著降低相关（所有P < 0.001）。相对于OAA，接受PP治疗的患者的年均全因（成本差异 = -$10,473；95% CI，-$17,827至-$3491）和SA相关（成本差异 = -$8457；95% CI，-$12,710至-$3638）医疗成本也更低（所有P < 0.001）。
与OAA相比，PP与显著的医疗总成本节省相关，这是由于精神分裂症合并SA的患者住院次数减少以及SA相关医疗保健资源利用率降低。因此，PP似乎是该亚组患者的一种有价值的治疗选择。
