a Analysis Group Inc. , Montréal , QC , Canada.
b Janssen Scientific Affairs LLC , Titusville , NJ , USA.
Curr Med Res Opin. 2018 Aug;34(8):1377-1388. doi: 10.1080/03007995.2018.1442822. Epub 2018 Feb 28.
To compare treatment patterns and Medicaid spending between schizophrenia patients initiating once-monthly paliperidone palmitate (PP1M) and oral atypical antipsychotics (OAAs) within four comorbid populations: cardiovascular disease (CVD), diabetes, hypertension and obesity.
Five-state Medicaid data identified comorbid adults with schizophrenia initiating PP1M or OAAs (index) from September 2009 balanced with inverse probability of treatment weighting. Chi-squared and t-tests compared index antipsychotic (AP) exposure (no gap >90 days) duration, AP polypharmacy, and index AP adherence (proportion of days covered ≥80%) and persistence (no gap ≥60 days) at 12 months post-index. Linear models with a non-parametric bootstrap procedure compared costs.
PP1M patients consistently had longer index AP exposure (e.g. CVD: 244 vs. 189 days; p < .001) and less AP polypharmacy (e.g. CVD: 21.1% vs. 28.1%; p < .001) versus OAA patients. Relative to OAA patients, adherence was more likely in PP1M patients with CVD or obesity (e.g. CVD: 28.6% vs. 22.1%; p < .001) and less likely for patients with diabetes (22.0% vs. 24.4%; p = .031). Persistence was consistently more likely for PP1M versus OAA patients (e.g. CVD: 49.9% vs. 27.4%; p < .001). Total costs were not significantly different between PP1M and OAA patients for any comorbidity. PP1M patients with diabetes, hypertension or obesity had higher pharmacy and lower medical costs (all p < .05).
Treatment with PP1M versus OAAs may reduce AP polypharmacy and increase AP persistence in comorbid patients with schizophrenia, without increasing total healthcare costs. Comorbidities are a highly prevalent driver of excess mortality in this vulnerable population; thus, future studies should specifically address the real-world effectiveness of therapies, including long acting injectable therapies (LAIs), for these patients.
比较精神分裂症患者起始使用每月注射 1 次棕榈酸帕利哌酮（PP1M）与口服非典型抗精神病药（OAAs）在 4 种合并症人群中的治疗模式和医疗补助支出：心血管疾病（CVD）、糖尿病、高血压和肥胖症。
利用 5 个州的医疗补助数据，通过逆概率治疗加权（inverse probability of treatment weighting），确定起始使用 PP1M 或 OAAs 的合并症成年精神分裂症患者（索引患者），并进行了 90 天以上无治疗间隙的比较。采用卡方检验和 t 检验比较索引抗精神病药（AP）暴露（无治疗间隙>90 天）持续时间、AP 联合用药和索引 AP 依从性（覆盖天数比例≥80%）和持续时间（无治疗间隙≥60 天），时间点为索引后 12 个月。使用非参数引导程序的线性模型比较了成本。
PP1M 患者的索引 AP 暴露持续时间（如 CVD：244 天 vs. 189 天；p<0.001）和 AP 联合用药较少（如 CVD：21.1% vs. 28.1%；p<0.001），与 OAA 患者相比，PP1M 患者更可能坚持用药，尤其是 CVD 或肥胖症患者（如 CVD：28.6% vs. 22.1%；p<0.001），而糖尿病患者的依从性则较低（22.0% vs. 24.4%；p=0.031）。PP1M 患者的持续时间始终高于 OAA 患者（如 CVD：49.9% vs. 27.4%；p<0.001）。对于任何合并症，PP1M 患者的总医疗费用与 OAA 患者相比均无显著差异。患有糖尿病、高血压或肥胖症的 PP1M 患者的药房费用较高，医疗费用较低（均 p<0.05）。
与 OAAs 相比，PP1M 治疗可能会减少合并精神分裂症患者的 AP 联合用药，并提高 AP 的持续时间，而不会增加总体医疗保健费用。合并症是导致该脆弱人群死亡率过高的一个高度流行的驱动因素；因此，未来的研究应特别针对这些患者的治疗方法（包括长效注射疗法）的实际效果进行研究。
