Health Outcomes Among Patients Diagnosed with Schizophrenia in the US Veterans Health Administration Population Who Transitioned from Once-Monthly to Once-Every-3-Month Paliperidone Palmitate: An Observational Retrospective Analysis

  • Charmi Patel
  • Antoine El Khoury
  • Ahong HuangEmail author
  • Li Wang
  • Onur Baser
  • Kruti Joshi
Original Research



There is limited literature on treatment patterns, healthcare resource utilization (HRU), and costs among patients who transition from once-monthly paliperidone palmitate (PP1M) to once-every-3-month paliperidone palmitate (PP3M) in a real-world setting. Hence, this study compared treatment patterns, HRU, and costs 12-month pre- and post-PP3M transition among Veteran’s Health Administration (VHA) patients with schizophrenia.


Patients with schizophrenia (aged ≥ 18 years) who initiated PP1M and transitioned per on-label criteria to PP3M (no treatment gap of > 45 days in PP1M during the 4 months prior, same dose strength of the last two PP1M claims, and appropriate dose conversion from last PP1M to first PP3M claim) from January 2015 to March 2017 were included from the VHA database. The first transition date to PP3M was identified as the index date. Patients were required to have 12-month pre- and post-PP3M continuous health plan eligibility. Outcomes were compared using the Wilcoxon-signed rank and McNemar’s test, appropriately.


The study included 122 patients [mean (SD) age: 54 (13.7) years]. Pre- and post-PP3M transition, 64.8% and 61.5% of patients were adherent (proportion of days covered ≥ 80%) to PP1M and PP3M, respectively. Comparison of HRU outcomes pre- and post-PP3M transition exhibited lower all-cause outpatient (37.5 vs. 31.1, p < 0.0001) and pharmacy visits (56.1 vs. 46.7, p < 0.0001). Similar trends were seen for mental health and schizophrenia-related outpatient and pharmacy HRU. Comparison of cost outcomes resulted in lower all-cause outpatient ($27,221 vs. $22,356, p = 0.0033), higher pharmacy ($16,349 vs. $17,003, p = 0.0076), lower total medical ($35,834 vs. $28,900, p = 0.0257), and no difference in total costs ($52,183 vs. $45,903, p = 0.3118). Similar trends were seen for mental health and schizophrenia-related costs.


Transition to PP3M was associated with a decline in outpatient and pharmacy visits. All-cause medical cost reduction fully offset increased pharmacy costs among VHA patients with schizophrenia who transitioned from PP1M to PP3M.


Janssen Scientific Affairs.


Antipsychotic agents Healthcare costs Schizophrenia Medication adherence Neurology Paliperidone palmitate 




This study and the Rapid Service Fee were funded, without restriction, by Janssen Scientific Affairs, LLC, 920 Rte. 202, Raritan, NJ, 08869. All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis.

Medical Writing, Editorial, and Other Assistance

Research assistance in the preparation of this article was provided by Jien Li and Catherine Callan of SIMR, LLC, and Richa Bashyal, a former employee of the same. Administrative assistance was provided by Michael Kane of SIMR, LLC. Support for this assistance was funded by Janssen Scientific Affairs, LLC.


All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.


Ahong Huang is an employee of SIMR, LLC, a paid consultant to Janssen Scientific Affairs. Li Wang is an employee of SIMR, LLC, a paid consultant to Janssen Scientific Affairs.Charmi Patel is an employee of Janssen Scientific Affairs and stockholders of Johnson & Johnson. Onur Baser consults for SIMR, LLC. AEK is an employee of Janssen Scientific Affairs and stockholders of Johnson & Johnson. Kruti Joshi is an employee of Janssen Scientific Affairs and stockholders of Johnson & Johnson.

Compliance with Ethics Guidelines

Neither institutional review board approval nor consent was necessary for this study, as it was a retrospective analysis conducted with de-identified data; no identifiable patient information or medical records were disclosed for the purposes of this study except in compliance with applicable law. Since the core study did not involve the collection, use, or transmittal of individual identifiable data, the conduct of this study was exempt from institutional review board approval, per the Federal Policy for the Protection of Human Subjects (1991).

Data Availability

The datasets generated and analyzed during the current study are included in the published version.

Supplementary material

12325_2019_1039_MOESM1_ESM.pdf (378 kb)
Supplementary material 1 (PDF 378 kb)


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Copyright information

© Springer Healthcare Ltd., part of Springer Nature 2019

Authors and Affiliations

  • Charmi Patel
    • 1
  • Antoine El Khoury
    • 1
  • Ahong Huang
    • 2
    Email author
  • Li Wang
    • 2
  • Onur Baser
    • 3
  • Kruti Joshi
    • 1
  1. 1.Janssen Scientific Affairs, LLCRaritanUSA
  2. 2.STATinMEDPlanoUSA
  3. 3.Department of EconomicsMEF UniversityIstanbulTurkey

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