Medication Adherence, Healthcare Resource Utilization, and Costs Among Medicaid Beneficiaries With Schizophrenia Treated With Once-monthly Paliperidone Palmitate or Once-every-three-months Paliperidone Palmitate

Background: Antipsychotics with reduced dosing frequency may improve adherence and clinical outcomes for patients with schizophrenia. This study compared adherence, persistence, healthcare resource utilization (HRU), and costs between Medicaid beneficiaries with schizophrenia treated with once-monthly paliperidone palmitate (PP1M) and those who transitioned to once-every-three-months paliperidone palmitate (PP3M).

Methods: Four-state Medicaid database (05/18/2014-03/31/2019) was used to identify adults with schizophrenia. The index date was the first PP3M claim (PP3M cohort) or a random PP1M claim (PP1M cohort) following ≥4 months of continuous PP1M treatment, with ≥12 months of continuous Medicaid enrollment pre- and post-index. Adherence (proportion of days covered by the index treatment ≥80%), persistence (no gap >90/30 days in the PP3M/PP1M supply), HRU, and costs were compared between cohorts matched 1:1 during the 12-month post-index period.

Results: A total of 2,374 patients were included. After matching, 374 patients remained in each cohort (mean age ≈42 years; 30.5% female). The PP3M cohort was 2.39 times more likely to be adherent (p<0.001), 4.63 times more likely to be persistent (p<0.001), 33% less likely to have ≥1 hospitalization (p=0.011), and 32% less likely to have ≥1 day with home care services use (p=0.012) compared to the PP1M cohort. Mean annual medical costs were $24,970 in the PP3M and $25,736 in the PP1M cohort (p=0.854). 

Conclusions: Medicaid beneficiaries who transitioned to PP3M had a higher adherence and persistence, and a reduced likelihood of hospitalization relative to those treated with PP1M. There may be an added clinical value to transitioning eligible patients to PP3M.