2026 Eastern States Conference

Title: Cost-effectiveness of paliperidone long-acting injectable antipsychotic vs oral second-generation antipsychotics in patients hospitalized for psychosis

Authors: Baylee Beaver, PharmD, MBA; Michaela E. Huddleston, PharmD, BCPS, BCGP, BCPP; Lora Good, PharmD; Patrick Kerr, PhD; Jonathan Robles-Diaz, PharmD; Brian Burton, MS

Background: This study evaluates the true cost-effectiveness of paliperidone long-acting injectable (LAI) in patients with schizophrenia and schizoaffective disorder to guide clinical practice and administrative decisions regarding antipsychotic selection.  

Methods: Medical records of 200 patients admitted to the inpatient psychiatric unit at CAMC General Hospital for schizophrenia or schizoaffective disorder from September 1st, 2016, to September 1st, 2024, were reviewed. Data collected included patient demographics, prescribed second-generation antipsychotic information, hospital length of stay (LOS) and cost, number of emergency department (ED) visits and hospital inpatient admissions in the 12-months before and after the index admission, and social determinants of health.

Results: The mean admission cost of patients discharged paliperidone LAIs was lower compared to patients discharged on oral second-generation antipsychotic agents ($76,964.40 vs $43,049.80, p<0.0001). Patients started on paliperidone LAI had longer LOS on the index admission compared to patients on oral second-generation antipsychotics (10.98 days vs 8.69 days, P=0.0001). No difference was identified in the number of readmissions or ED visits between groups. Among patients who were readmitted, there was no difference in LOS between the two groups. 

Conclusions: Paliperidone LAIs were associated with lower admission costs despite the association with a longer length of stay. However, there was no improvement in the rate of readmissions and emergency department visits.