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Lafeuille MH, Grittner AM, Fortier J, Muser E, Fasteneau J, Duh MS, Lefebvre P. Comparison of rehospitalization rates and associated costs among patients with schizophrenia receiving paliperidone palmitate or oral antipsychotics. Am J Health Syst Pharm 2015; 72:378-89. [PMID: 25694413 DOI: 10.2146/ajhp140219] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Comparative data on rehospitalization patterns and associated institutional costs after inpatient treatment with paliperidone palmitate or oral antipsychotic therapy are reported. METHODS A retrospective cohort study was conducted using discharge and billing records from a large hospital database. Selected clinical and cost outcomes were compared in a cohort of adult patients who received the long-acting antipsychotic paliperidone palmitate during a schizophrenia-related index hospital stay and a cohort of patients who received oral antipsychotic therapy during their index admission. Inverse probability-of-treatment weights based on propensity scores were used to reduce confounding. Rates of all-cause and schizophrenia-related rehospitalization and emergency room (ER) use in the two cohorts over periods of up to 12 months were analyzed using a multivariate Cox proportional hazard model. Institutional costs for the evaluated postdischarge events were compared via multivariate linear regression analysis. RESULTS In the first 12 months after index hospital discharge, the risk of all-cause rehospitalization and ER use was significantly lower in the paliperidone palmitate cohort than in the oral antipsychotic cohort (hazard ratio, 0.61; 95% confidence interval [CI], 0.59-0.63; p < 0.0001); institutional costs during the first 6 months after discharge were significantly lower in the paliperidone palmitate cohort than in the comparator group (adjusted mean monthly cost difference -$404; 95% CI, -$781 to -$148; p < 0.0001). CONCLUSION The use of paliperidone palmitate therapy during patients' index hospital admission for schizophrenia was associated with a reduced risk of hospital readmission or ER use and lower postdischarge institutional costs.
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Affiliation(s)
- Marie-Hélène Lafeuille
- Marie-Hélène Lafeuille, M.A., is Senior Economist; Amanda Melina Grittner, M.A., is Economist; and Jonathan Fortier, M.A., is Economist, Groupe d'analyse, Ltée, Montréal, Canada. Erik Muser, Pharm.D., M.P.H., is Associate Director, Translational Science; and John Fasteneau, M.P.H., is Senior Director, Health Economics and Outcomes Research, Janssen Scientific Affairs, LLC, Titusville, NJ. Mei Sheng Duh, M.P.H., Sc.D., is Managing Principal,Analysis Group, Inc., Boston, MA. Patrick Lefebvre, M.A., is Vice President, Groupe d'analyse, Ltée.
| | - Amanda Melina Grittner
- Marie-Hélène Lafeuille, M.A., is Senior Economist; Amanda Melina Grittner, M.A., is Economist; and Jonathan Fortier, M.A., is Economist, Groupe d'analyse, Ltée, Montréal, Canada. Erik Muser, Pharm.D., M.P.H., is Associate Director, Translational Science; and John Fasteneau, M.P.H., is Senior Director, Health Economics and Outcomes Research, Janssen Scientific Affairs, LLC, Titusville, NJ. Mei Sheng Duh, M.P.H., Sc.D., is Managing Principal,Analysis Group, Inc., Boston, MA. Patrick Lefebvre, M.A., is Vice President, Groupe d'analyse, Ltée
| | - Jonathan Fortier
- Marie-Hélène Lafeuille, M.A., is Senior Economist; Amanda Melina Grittner, M.A., is Economist; and Jonathan Fortier, M.A., is Economist, Groupe d'analyse, Ltée, Montréal, Canada. Erik Muser, Pharm.D., M.P.H., is Associate Director, Translational Science; and John Fasteneau, M.P.H., is Senior Director, Health Economics and Outcomes Research, Janssen Scientific Affairs, LLC, Titusville, NJ. Mei Sheng Duh, M.P.H., Sc.D., is Managing Principal,Analysis Group, Inc., Boston, MA. Patrick Lefebvre, M.A., is Vice President, Groupe d'analyse, Ltée
| | - Erik Muser
- Marie-Hélène Lafeuille, M.A., is Senior Economist; Amanda Melina Grittner, M.A., is Economist; and Jonathan Fortier, M.A., is Economist, Groupe d'analyse, Ltée, Montréal, Canada. Erik Muser, Pharm.D., M.P.H., is Associate Director, Translational Science; and John Fasteneau, M.P.H., is Senior Director, Health Economics and Outcomes Research, Janssen Scientific Affairs, LLC, Titusville, NJ. Mei Sheng Duh, M.P.H., Sc.D., is Managing Principal,Analysis Group, Inc., Boston, MA. Patrick Lefebvre, M.A., is Vice President, Groupe d'analyse, Ltée
| | - John Fasteneau
- Marie-Hélène Lafeuille, M.A., is Senior Economist; Amanda Melina Grittner, M.A., is Economist; and Jonathan Fortier, M.A., is Economist, Groupe d'analyse, Ltée, Montréal, Canada. Erik Muser, Pharm.D., M.P.H., is Associate Director, Translational Science; and John Fasteneau, M.P.H., is Senior Director, Health Economics and Outcomes Research, Janssen Scientific Affairs, LLC, Titusville, NJ. Mei Sheng Duh, M.P.H., Sc.D., is Managing Principal,Analysis Group, Inc., Boston, MA. Patrick Lefebvre, M.A., is Vice President, Groupe d'analyse, Ltée
| | - Mei Sheng Duh
- Marie-Hélène Lafeuille, M.A., is Senior Economist; Amanda Melina Grittner, M.A., is Economist; and Jonathan Fortier, M.A., is Economist, Groupe d'analyse, Ltée, Montréal, Canada. Erik Muser, Pharm.D., M.P.H., is Associate Director, Translational Science; and John Fasteneau, M.P.H., is Senior Director, Health Economics and Outcomes Research, Janssen Scientific Affairs, LLC, Titusville, NJ. Mei Sheng Duh, M.P.H., Sc.D., is Managing Principal,Analysis Group, Inc., Boston, MA. Patrick Lefebvre, M.A., is Vice President, Groupe d'analyse, Ltée
| | - Patrick Lefebvre
- Marie-Hélène Lafeuille, M.A., is Senior Economist; Amanda Melina Grittner, M.A., is Economist; and Jonathan Fortier, M.A., is Economist, Groupe d'analyse, Ltée, Montréal, Canada. Erik Muser, Pharm.D., M.P.H., is Associate Director, Translational Science; and John Fasteneau, M.P.H., is Senior Director, Health Economics and Outcomes Research, Janssen Scientific Affairs, LLC, Titusville, NJ. Mei Sheng Duh, M.P.H., Sc.D., is Managing Principal,Analysis Group, Inc., Boston, MA. Patrick Lefebvre, M.A., is Vice President, Groupe d'analyse, Ltée
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Lafeuille MH, Grittner AM, Lefebvre P, Ellis L, McKenzie RS, Slaton T, Kozma C. Adherence patterns for abiraterone acetate and concomitant prednisone use in patients with prostate cancer. J Manag Care Spec Pharm 2014; 20:477-84. [PMID: 24761819 PMCID: PMC10437892 DOI: 10.18553/jmcp.2014.20.5.477] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND With the growing use of oral anticancer medications, understanding adherence patterns has become increasingly important. Abiraterone acetate (AA) is a prodrug of abiraterone, a novel androgen biosynthesis inhibitor. AA is approved for use in combination with prednisone for treatment of patients with metastatic castration-resistant prostate cancer. OBJECTIVE To evaluate AA and concomitant prednisone utilization and adherence patterns for patients with prostate cancer in the United States. METHODS This study used data from 2 administrative health care claims databases--Dataset 1: Truven Health Analytics MarketScan (December 2010 to August 2012) and Dataset 2: Symphony Health Solutions' ProMetis Lx (June 2009 to March 2013). To evaluate the consistency of medication-taking behavior, adherence was measured using medication possession ratio (MPR), which was calculated as the sum of days of supply divided by the days on therapy in patients with at least 2 AA prescriptions. Additional outcomes included the proportion of patients taking prednisone, mean and median daily dose of AA, and concomitant prednisone use. Adherence was also studied by age, health care plan type, or previous recent chemotherapy subgroups. RESULTS 515 patients (mean age: 72.2) and 3,228 patients (mean age: 72.2) with at least 1 AA claim were selected from Dataset 1 and Dataset 2, respectively. The mean (median) daily AA dose per person per prescription was 998.8 (1,000) mg for Dataset 1 and 994.2 (1,000) mg for Dataset 2, which is within 1% of the recommended daily dose (1,000 mg). Mean (median) MPR was 93% (98%; n = 492) in Study Population 1 and 93% (100%; n = 2,449) in Study Population 2. The mean (median) daily prednisone dose per person per prescription was similar in both datasets with 10.1 (10.0; n = 488) mg and 10.6 (10.0; n = 2,425) mg in Dataset 1 and 2, respectively. Similar adherence patterns were observed for patients in different age groups, for patients with commercial health care plans versus patients with Medicare coverage, and for patients with recent chemotherapy compared with patients without. CONCLUSIONS Results from 2 observational studies reported high levels of adherence to AA dosing and administration patterns consistent with prescribing information. These findings provide useful insights into the treatment patterns in patients with prostate cancer treated with AA and can contribute to the current discussion in oncologic research and practice.
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Affiliation(s)
| | | | - Patrick Lefebvre
- Groupe d’analyse, Ltée, 1000 De La Gauchetière W., Ste. 1200, Montréal, QC H3B 4W5.
| | - Lorie Ellis
- Groupe d’analyse, Ltée, 1000 De La Gauchetière W., Ste. 1200, Montréal, QC H3B 4W5.
| | - R. Scott McKenzie
- Groupe d’analyse, Ltée, 1000 De La Gauchetière W., Ste. 1200, Montréal, QC H3B 4W5.
| | - Terra Slaton
- Groupe d’analyse, Ltée, 1000 De La Gauchetière W., Ste. 1200, Montréal, QC H3B 4W5.
| | - Chris Kozma
- Groupe d’analyse, Ltée, 1000 De La Gauchetière W., Ste. 1200, Montréal, QC H3B 4W5.
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