Medical inquiries

Connect with my medical science liaison

Chat live

Available Monday - Friday 9AM - 4:30PM ET

Call me now

Available Monday - Friday 9AM - 7:30PM ET

Email your inquiry

Call 1-800-526-7736

Available Monday - Friday 9AM - 8PM ET

Live video

Available Monday - Friday 9AM - 4:30PM ET

This information is intended for US healthcare professionals to access current scientific information about J&J Innovative Medicine products. It is prepared by Medical Information and is not intended for promotional purposes, nor to provide medical advice.

INVEGA TRINZA® (paliperidone palmitate)

Medical Information

+ Save link

INVEGA TRINZA - Pharmacoeconomic Outcomes

Last Updated: 02/19/2025

Summary

INVEGA TRINZA (paliperidone palmitate), a 3-month injection, is an atypical antipsychotic indicated for the treatment of schizophrenia in patients after they have been adequately treated with INVEGA SUSTENNA^® (paliperidone palmitate 1-month) for at least 4 months.¹
Post hoc analyses comparing healthcare resource utilization (HRU) from 2 clinical trials demonstrated that hospitalizations were significantly lower in patients treated with INVEGA TRINZA vs placebo and odds of hospitalization were not significantly different between INVEGA TRINZA and INVEGA SUSTENNA.²
Real-world studies in adult Medicaid patients with schizophrenia demonstrated that INVEGA TRINZA had better adherence and persistence, lower rates of inpatient admissions and days with home care services compared to patients who remained on INVEGA SUSTENNA.³^,⁴
In several retrospective cohort studies in Veterans Health Administration (VHA) patients with schizophrenia, patients who transitioned to INVEGA TRINZA had better adherence, experienced shorter all-cause inpatient length of stay (LOS), had lower average number of schizophrenia-related pharmacy visits, and fewer number of visits to outpatient facilities and pharmacy compared to those who remained on INVEGA SUSTENNA.⁵^,⁶
In another retrospective observational analysis in commercially insured patients with schizophrenia, INVEGA TRINZA transition was associated with improvement in certain comorbidity-related outcomes.⁷
Several real-world analyses of commercially insured, VHA and Medicaid patients with schizophrenia evaluating healthcare costs showed lower or similar medical cost and an increase or no change in pharmacy costs in patients who transitioned from INVEGA SUSTENNA to INVEGA TRINZA compared to those remained on INVEGA SUSTENNA, or in the same group of patients after transitioning to INVEGA TRINZA compared to before transitioning.³^-⁶
In a retrospective study in Oklahoma Medicaid members with schizophrenia or schizoaffective disorder, improved adherence and persistence with fewer hospital readmissions were observed in switches from oral antipsychotic (OAP) to INVEGA SUSTENNA/INVEGA TRINZA vs OAP to OAP switches. OAP-switches were associated with an adjusted pre- to post-index change of approximately -49% relative to switches to INVEGA SUSTENNA/INVEGA TRINZA (P<0.001).⁸
Substantial cost savings were realized in a cost model that evaluated switching nonadherent patients with schizophrenia from oral atypical antipsychotic (OAA) to INVEGA SUSTENNA and then subsequently transitioning to INVEGA TRINZA and INVEGA HAFYERA.⁹

CLinical DATA

United States (US) HRU, Cost, and Treatment Patterns

Studies assessing treatment patterns, HRU and costs following treatment with INVEGA TRINZA have been conducted in patients treated for schizophrenia. Outcomes of these studies, focused on all-cause results, are summarized in Table: US HRU, Cost Outcomes, and Treatment Patterns - INVEGA TRINZA vs INVEGA SUSTENNA or OAPs.

US HRU, Cost Outcomes, and Treatment Patterns - INVEGA TRINZA vs INVEGA SUSTENNA or OAPs

INVEGA TRINZA vs INVEGA SUSTENNA
Dickson et al (2023)⁸ conducted a retrospective study evaluating the medication use patterns, readmissions, and total direct costs among adults (aged 18-64 years) with schizophrenia or schizoaffective disorder who were previously treated with an OAP and switched to INVEGA SUSTENNA or another OAP (OAP-switch). Data Source: Oklahoma Medicaid claims from January 1, 2016 to December 31, 2020 Sample Size: Among 295 Medicaid members meeting full inclusion criteria; n=183 were included in INVEGA SUSTENNA/INVEGA TRINZA cohort (44 INVEGA SUSTENNA cases transitioned to INVEGA TRINZA), and n=112 were included in OAP-switch cohort. Adherence: The multivariable-adjusted odds of readmission were significantly associated with a 45day treatment gap (P<0.05) and nonadherence (i.e., PDC<80%) (P<0.05). Relative to INVEGA SUSTENNA/INVEGA TRINZA, the multivariable analyses also indicated that OAP switch was associated with an 18.5% lower PDC, 92.3% higher number of 45-day treatment gaps, and an approximately 90% higher odds of all-cause 30-day readmission (P<0.05). Healthcare Costs: The adjusted pre- to post-index change in cost was approximately 49% lower for OAP-switches vs INVEGA SUSTENNA/INVEGA TRINZA (P<0.001), although unadjusted post-index costs did not differ between groups (P=0.440). HRU: The OAP-switch cohort had a higher proportion of any 30-day post-index readmission compared with the INVEGA SUSTENNA/INVEGA TRINZA cohort (42.0% vs 33.3%, P=0.042). When controlling for a PDC≥80% as a dichotomous measure of adherence in the multivariable analysis of SCZ or SCD resource utilization, OAP-switches were significantly associated with 87.4% higher adjusted odds of any 30-day readmission relative to INVEGA SUSTENNA/INVEGA TRINZA (OR [95% CI], 1.874, 1.031-3.411, P=0.030). Conclusion: This real-world investigation of adult Medicaid members with schizophrenia or schizoaffective disorder observed improved adherence and persistence with fewer readmissions with INVEGA SUSTENNA/INVEGA TRINZA vs OAP-switches.
Morrison et al (2023)⁹ evaluated the impact on healthcare costs and relapse rates of switching nonadherent patients with schizophrenia from OAA to INVEGA SUSTENNA and then subsequently transitioning to INVEGA TRINZA and INVEGA HAFYERA using a cost model. Data Source: Medicaid beneficiary data Sample Size: Adult patients who were nonadherent to OAA and experienced a recent relapse: n=7,454; young adults (aged 18-35 years) who were nonadherent to OAA, regardless of recent relapse: n=4,002 Total Cost Saved and Relapse Avoided (Nonadherent and Recently Relapsed Adults): Subsequent transition from INVEGA SUSTENNA to INVEGA TRINZA and INVEGA HAFYERA increased the total number of relapses avoided to 631, 1,262, and 6,312 when 5%, 10%, and 50% of patients were switched to INVEGA SUSTENNA before subsequent relapses, respectively, and the cumulative plan-level savings were $9.1M, $18.1M, and $90.7M, respectively. The total number of relapses avoided were 4,987 when 50% of patients were switched to INVEGA SUSTENNA after a subsequent relapse, and the cumulative plan-level savings were $69.1M. Total Cost Saved and Relapse Avoided (Nonadherent, Young Adults): Subsequent transition from INVEGA SUSTENNA to INVEGA TRINZA and INVEGA HAFYERA increased the total number of relapses avoided to 223, 447, and 2,233 when 5%, 10%, and 50% of patients were switched to INVEGA SUSTENNA before subsequent relapses, respectively, and the cumulative plan-level savings increased to $2.0M, $3.9M, and $19.6M, respectively, over 3 years. The cumulative relapses avoided were 1,472 after 3 years when 50% of patients were switched to INVEGA SUSTENNA following subsequent relapses, and the cumulative plan-level savings increased to $10.8M. Cost: Subsequent transition from INVEGA SUSTENNA to INVEGA TRINZA and INVEGA HAFYERA: Yielded higher cost savings per patient switched of $9,220, $8,385, and $6,723 when 5%, 10%, and 50% of nonadherent, recently relapsed adults were switched to INVEGA SUSTENNA before subsequent relapses, respectively. Yielded higher cost savings per patient switched of $3,405, $3,522, and $2,860 when 5%, 10%, and 50% of nonadherent, young adults were switched to INVEGA SUSTENNA before subsequent relapses, respectively. Conclusion: Switching nonadherent, recently relapsed patients to INVEGA SUSTENNA before subsequent relapses yielded substantial cost savings and avoided relapses. Further, subsequently transitioning these patients to INVEGA TRINZA and/or INVEGA HAFYERA can lead to incremental cost savings and relapses avoided.
Lin et al (2021)⁴ conducted a retrospective, observational, matched cohort study evaluating adherence, persistence, HRU, and cost in Medicaid beneficiaries with schizophrenia who transitioned from INVEGA SUSTENNA to INVEGA TRINZA vs those who remained on INVEGA SUSTENNA. Data Source: Medicaid data from Iowa (Q2 2014 to Q3 2016), Kansas (Q2 2014 to Q1 2019), Mississippi (Q2 2014 to Q1 2019), and Missouri (Q2 2014 to Q1 2019) Sample Size (Matched Cohorts): INVEGA TRINZA (patients who received adequate treatment with INVEGA SUSTENNA and then transitioned to INVEGA TRINZA): n=374; INVEGA SUSTENNA (patients who received adequate treatment with and remained on INVEGA SUSTENNA): n=374 Treatment Patterns: Adherence: Compared to patients in the INVEGA SUSTENNA cohort, patients in the INVEGA TRINZA cohort were 3.5 and 2.4 times more likely to be adherent to any antipsychotic and to the index medication, respectively (all P<0.001) at 12 months. Persistence: During the 12-month follow-up period, patients in the INVEGA TRINZA cohort were 4.6 times more likely to be persistent on the index medication than patients in the INVEGA SUSTENNA cohort (P<0.001). HRU: During the 12-month follow-up period, compared to patients in the INVEGA SUSTENNA cohort, patients in the INVEGA TRINZA cohort were 33% times less likely to have ≥1 inpatient admission (P=0.011) and 32% times less likely to have ≥1 day with home care services use (P=0.012). Healthcare Costs: The total mean annual medical costs were lower in the INVEGA TRINZA ($24,970) vs INVEGA SUSTENNA ($25,736) cohort (mean cost difference, -$767; P=0.854). Conclusion: Patients who transitioned to INVEGA TRINZA had better adherence and persistence, lower rates of inpatient admissions and days with home care services compared to patients who remained on INVEGA SUSTENNA.
El Khoury et al (2021)⁶ conducted a retrospective cohort study comparing treatment patterns, healthcare utilization, and costs among VHA patients with schizophrenia who transitioned to INVEGA TRINZA vs those who remained on INVEGA SUSTENNA. Data Source: VHA data between January 1, 2014, and March 31, 2018 Sample Size: Before PSM: n=3,230 (INVEGA TRINZA: n=257; INVEGA SUSTENNA: n=2,973); after PSM: n=222 (INVEGA TRINZA: n=111; INVEGA SUSTENNA: n=111). Outcomes: Before PSM, a significantly higher proportion of patients who remained on INVEGA SUSTENNA vs those who switched to INVEGA TRINZA experienced anxiety (20.0% vs 12.5%; STD: 20.6), tobacco use (43.2% vs 28.4%; STD: 31.2), any depression disorder (36.2% vs 26.5%; STD: 21.1), and substance abuse (44.2% vs 37.4%; STD: 13.9). After PSM, veteran patients who transitioned to INVEGA TRINZA vs those who remained on INVEGA SUSTENNA showed the following results: *Treatment Patterns:* Significantly higher rates of adherence (PDC ≥80%, 78.4% vs 57.7%; P=0.0009) and mean±SD PDC (0.9±0.2 vs 0.7±0.3; P<0.0001) was observed among patients who transitioned to INVEGA TRINZA compared to INVEGA SUSTENNA cohort. *HRU:* Shorter all-cause inpatient LOS PPPY (3.0 vs 8.3 days; P=0.0354) was observed, with no statistically significant differences in the numbers of all-cause inpatient stays (P=0.1471), outpatient visits (P=0.8335), or prescription fills PPPY (P=0.2893). Significantly shorter mental health-related (2.5 vs 13.7 days; P=0.0214) and schizophrenia-related (1.4 vs 11.3 days; P=0.0362) inpatient LOS PPPY were observed. *Healthcare Costs:* Higher all-cause pharmacy costs PPPY ($15,987 vs $11,381; P=0.0004) were fully offset by lower total medical costs ($29,210 vs $38,297; P=0.1010), and no statistically significant difference was observed in total costs PPPY ($45,198 vs $49,678; P=0.4433). Conclusion: VHA patients who transitioned to INVEGA TRINZA vs remained on INVEGA SUSTENNA experienced shorter all-cause inpatient LOS, lower average number of schizophrenia-related prescription fills, reduction in all-cause medical costs fully offsetting the increased all-cause pharmacy costs, and improvement in medication adherence.
INVEGA TRINZA vs OAPs
Gilligan et al (2018)¹⁰ conducted a retrospective cohort study comparing adherence and persistence between schizophrenia patients who initiated INVEGA SUSTENNA and those who transitioned to INVEGA TRINZA according to the label vs OAA. Data Source: Truven Health MarketScan^® Medicaid Multi-State Database from January 1, 2010 to June 30, 2016 Sample Size: On-label INVEGA TRINZA: n=105; INVEGA SUSTENNA: n=3,794; OAA: n=9,754 Treatment Patterns: Adherence: Compared with OAA patients, those treated with on-label INVEGA TRINZA or INVEGA SUSTENNA had significantly higher mean PDC (0.79 for on-label INVEGA TRINZA and 0.55 for INVEGA SUSTENNA vs 0.42 for OAA; P<0.001 for both values), and significantly higher proportion of patients with PDC≥80% (66% for on-label INVEGA TRINZA and 32% for INVEGA SUSTENNA vs 21% OAA, P<0.001 for both values). Persistence: Compared with OAA patients, those treated with on-label INVEGA TRINZA or INVEGA SUSTENNA had significantly lower nonpersistence at 30 days (81% INVEGA SUSTENNA and 36% on-label INVEGA TRINZA vs 86% OAA, P<0.001 for both values), significantly lower nonpersistence at 60 days (69% INVEGA SUSTENNA and 25% on-label INVEGA TRINZA vs 79% OAA, P<0.001 for both values), and significantly lower nonpersistence at 90 days (21% INVEGA SUSTENNA and 11% on-label INVEGA TRINZA vs 29% OAA, P<0.001 for both values). Polypharmacy: Significantly lower post-index psychiatric polypharmacy was observed for INVEGA SUSTENNA (48%) and on-label INVEGA TRINZA (31%) compared to OAA (52%); P<0.001 for both values. Conclusion: Among Medicaid patients, on-label INVEGA TRINZA and INVEGA SUSTENNA patients are associated with significantly higher adherence and persistence and significantly lower psychiatric polypharmacy compared to OAA patients.
Abbreviations: CI, confidence interval; HRU, healthcare resource utilization; LOS, length of stay; OAA, oral atypical antipsychotic; OAP, oral antipsychotic; OR, odds ratio; PDC, proportion of days covered; PPPY, per-patient-per-year; PSM, propensity score matching; Q, quartile; SCD, schizoaffective disorder; SCZ, schizophrenia; SD, standard deviation; STD, standardized difference; US, United States; VHA, Veterans Health Administration.

Single- and Dual-Arm “Real-World” Utilization

Single- and dual-arm studies evaluating the “real-world” utilization of INVEGA TRINZA have been conducted. Results are summarized in Table: Single- and Dual-Arm “Real-World” Utilization Health Outcomes Results.

Single- and Dual-Arm “Real-World” Utilization Health Outcomes Results

Single-Arm Studies
Chang et al (2024)¹¹ conducted a retrospective 24-month mirror-image study to evaluate HRU and costs before vs after treatment with INVEGA TRINZA in adult patients (between 18 to 75 years old) with schizophrenia who were on INVEGA SUSTENNA for ≥12 months before switching to INVEGA TRINZA, and maintained treatment on INVEGA TRINZA for ≥12 months. The initiation date of INVEGA TRINZA was considered the mirror point of the study. Data Source: EHR from the Psychiatric Outpatient Department of Dalin Tzu Chi Hospital, Taiwan, between December 2021 and October 2023 Sample Size: N=34 Outcomes: After initiating INVEGA TRINZA, 91.2% of patients reported no ADRs, while 8.8% experienced the following: injection site reaction with pain and swelling (n=1; the reaction resolved within 3 days), tiredness for 1 day after injection (n=1), and poor diabetes control leading to increased dosage of antidiabetics (n=1) HRU: The mean duration of hospitalization at 12 months before INVEGA TRINZA vs after was 53.6±93.9 vs 28.5±69.8 days (P=0.02) The mean number of emergency room visits 12 months before INVEGA TRINZA vs after were 0.3 vs 0.0 (P=0.05) There was a decrease in outpatient visits and psychiatric hospitalization after starting INVEGA TRINZA, but these data points did not reach significance. Costs: Healthcare costs 12 months before INVEGA TRINZA vs after were $NT107,328.8±175,121.2 vs $NT57,848.6±132,797.2 (P=0.03) Conclusion: 12 months of treatment with INVEGA TRINZA significantly reduced the duration of hospitalizations, frequency of emergency room visits, and overall costs.
Emond et al (2019)⁷ conducted a retrospective observational analysis comparing comorbidity-related outcomes, adherence to AP, HRU, and costs pre- (6 months before) and post- (6 months after) transition to INVEGA TRINZA from INVEGA SUSTENNA in commercially insured patients with schizophrenia. Data Source: IQVIA PharMetrics Plus database from May 2014 to February 2018 Sample Size: N=152 Outcomes: Compared to pre-transition, post-transition comorbidity-related diagnosis claims were statistically less likely with psychoses (84.9% vs 76.3%; OR [95% CI]: 0.57 [0.35-0.94]; P=0.028), diabetes without chronic complications (23.0% vs 17.8%; OR: 0.72 [0.54-0.97]; P=0.031), drug abuse (16.4% vs 11.2%; OR: 0.64 [0.41-0.99]; P=0.044), and substance-related and addictive disorders (33.6% vs 22.4%; OR: 0.57 [0.41-0.79]; P<0.001). Treatment Patterns: Post-transition period was associated with a higher proportion of adherence, defined as PDC ≥80% (65.1% vs 78.9%; OR: 2.01 [1.21-3.33]; P=0.007) and nominally higher mean PDC (84% vs 87%; P=0.225). HRU: No differences were found in outpatient visits, ER visits, inpatient admissions, total number of inpatient days, and days with other medical services pre- vs post-transition to INVEGA TRINZA. Costs: Monthly all-cause pharmacy, medical and total costs pre- vs post-transition to INVEGA TRINZA remained similar: Monthly pharmacy costs ($2,158±966 vs $2,223±1,022; difference [95% CI]: $65 [-21 to 163]; P=0.140 Monthly medical cost: $545±1,211 vs $721±2,271; difference [95% CI]: $176 [-101 to 536]; P=0.284 Monthly total cost:$2,702±1,600 vs $2,944±2,605; difference [95% CI]: $242 [-43 to 630]; P=0.120 Conclusion: INVEGA TRINZA transition was associated with improvement in certain comorbidityrelated outcomes and medication adherence, while remaining cost neutral.
Patel et al (2019)⁵ conducted an observational retrospective analysis comparing treatment patterns, HRU, and costs related to 12 months pre- and post-transition from INVEGA SUSTENNA to INVEGA TRINZA in VHA patients with schizophrenia. Data Source: VHA data from January 2015 to March 2017 Sample Size: N=122 Treatment Patterns: Compared to the pre-transition period, 12-month post-INVEGA TRINZA transition period was associated with a similar rate of adherence, measured by proportion of patients with PDC ≥80% (64.8% with INVEGA SUSTENNA vs 61.5% with INVEGA TRINZA). HRU: Post-INVEGA TRINZA transition period was associated with a reduction in number of all-cause outpatient (37.5 vs 31.1, P<0.0001) and pharmacy visits (56.1 vs 46.7, P<0.0001). Costs: Compared to the pre-transition period, 12-month post-INVEGA TRINZA transition period was associated with increased pharmacy costs ($16,349 vs $17,003, P=0.0076) fully offset by decreased total medical costs ($35,834 vs $28,900, P=0.0257), resulting in similar all-cause total costs ($52,183 vs $45,903, P=0.3118). Conclusion: Transitioning from INVEGA SUSTENNA to INVEGA TRINZA among VHA patients was associated with a reduction in the number of visits to outpatient facilities and pharmacy. The reduction in all-cause medical cost fully offset increased pharmacy costs.
DerSarkissian et al (2018)¹² conducted a retrospective cohort study comparing treatment patterns, HRU, and associated healthcare costs pre-to-post INVEGA TRINZA transition in Veterans with schizophrenia who transitioned from INVEGA SUSTENNA to INVEGA TRINZA as per prescribing information. Data Source: EHR data from VHA between January 2009 and June 2017 Sample size: A total of 277 Veterans, 197 had ≥6 months of follow-up post-INVEGA TRINZA transition Treatment Patterns: 84.3% of Veterans with ≥4 months of follow-up after the first INVEGA TRINZA dose received a second dose; 67.9% of Veterans with ≥4 months of follow-up after the second INVEGA TRINZA dose received a third dose. Mean PDC of any AP increased (from 0.90 to 0.97) in the 6 months pre- and post-INVEGA TRINZA transition (P<0.0001). HRU: Veterans had fewer mean days in an inpatient setting (from 41.4 to 21.6; P=0.0164), smaller proportion of mental health inpatient stays (18.3% vs 12.2%; P=0.0285), and a decreased mean number of outpatient visits post-INVEGA TRINZA transition (31.0 vs 25.6; P<0.0001). Costs: Total overall costs decreased (from $27,745 to $23,772; P=0.005) post-INVEGA TRINZA transition, largely driven by a decrease in inpatient costs (from $10,503 to $8,178; P=0.0423) and outpatient costs (from $9,822 to $8,074; P<0.0001). Conclusion: Veterans with schizophrenia had reduced HRU and healthcare costs following the transition to INVEGA TRINZA according to prescribing recommendations.
Emond et al (2018)³ conducted a retrospective observational cohort study describing patient demographic and clinical characteristics among Medicaid patients who transitioned from INVEGA SUSTENNA to INVEGA TRINZA per prescribing guidelines, INVEGA TRINZA treatment patterns, and adherence to APs, HRU and costs before and after INVEGA TRINZA initiation. Data Source: Medicaid claims database from January 1, 2014 to March 31, 2017 Sample Size: N=151 had ≥12 months of continuous Medicaid eligibility following INVEGA TRINZA initiation. Treatment Patterns: Among patients with ≥12 months of observation post-INVEGA TRINZA initiation, the proportion of patients adherent to APs numerically increased from 66.2% in the 12-month baseline period to 70.2% in the first 12 months following INVEGA TRINZA initiation (OR=1.20; P=0.3758). HRU: The mean monthly number of one-day mental health institute visits decreased by 12% during the 12 months post-INVEGA TRINZA initiation compared to the 6 months pre-initiation (1.71 vs 1.51, P=0.0080). The mean monthly number of days with other services increased during the 12 months post-INVEGA TRINZA initiation compared to the 6 months pre-initiation (0.06 vs 0.21, P<0.0001). Costs: Total monthly healthcare costs remained similar during the 6 months pre- and the 12 months post-INVEGA TRINZA initiation ($3,371 vs $3,456; P=0.7000). No significant differences were observed in monthly medical costs ($1,565 vs $1,586; P=0.9040) and pharmacy costs ($1,805 vs $1,870; P=0.2960). Conclusion: Adherence to APs, HRU and spending remained similar before and after INVEGA TRINZA initiation, suggesting a cost-neutral option among this Medicaid population of patients with schizophrenia.
Joshi et al (2017)¹³ conducted a retrospective longitudinal, cohort design was used to assess the treatment patterns of INVEGA TRINZA in patients with schizophrenia initiated on INVEGA TRINZA who transitioned from INVEGA SUSTENNA. Data Source: Symphony Health Solutions database May 2014-September 2016 Sample Size: N=1,063 had a baseline period Treatment Patterns: Persistence to INVEGA TRINZA medication: Among the 794 patients with ≥4 months of follow-up after the first dose, 698 (87.9%) had a second dose. The strength of the first dose and the second dose were identical in 98.3% of the cases. 513 patients with ≥4 months of follow-up after the second dose, 459 (89.5%) had a third dose, which has the same strength as the previous dose for 96.5% of the patients. 380 (79.0%) had a third dose among the 481 patients with ≥8 months of follow-up after the first dose. Adherence to INVEGA TRINZA medication: The mean (SD) MPR was 0.97 (0.08) and 96.6% of the patients had an MPR ≥0.80. The proportion of patients with a PDC ≥0.80 at 6 months was 84.3%. HRU^a: A decrease in the proportion of patients with ≥1 ER visit (13.4% at the 4^th quarter to 9.2% at the 1^st quarter prior to INVEGA TRINZA initiation), ≥1 inpatient visit (6.5% at the 4^th quarter to 2.5% at the 1^st quarter prior to INVEGA TRINZA initiation), and ≥1 outpatient visit (48.9% at the 4^th quarter to 47.5% at the 1^st quarter prior to INVEGA TRINZA initiation) were observed. A decrease in the mean number of monthly ER (0.08 to 0.06), inpatient (0.03 to 0.01), outpatient (0.73 to 0.69) visits were also observed. Conclusion: Higher adherence to APs and lower HRU were observed patients initiated on INVEGA TRINZA transitioning from INVEGA SUSTENNA. In addition, patients initiated on INVEGA TRINZA were persistent and adherent to their treatment and received a stable dose over time.
Dual-Arm Study
Cirnigliaro et al (2023)¹⁴ conducted a 12-month, mirror-image, retrospective, observational study to evaluate the safety and efficacy of INVEGA TRINZA by comparing the HRU measures between patients who switched from INVEGA SUSTENNA to INVEGA TRINZA and those who did not. Data Source: 5 CMHCs and 1 Rehabilitation Community in Italy between 2022 and 2023. Sample Size: N=119 (INVEGA SUSTENNA, n=61 and INVEGA TRINZA, n=58) HRU: Mirror-Image Study: HRU measures before and after 12 months of INVEGA TRINZA use did not significantly change after initiation of INVEGA TRINZA. Number of visits to CMHCs decreased for a majority of the patients after using INVEGA TRINZA (median number of CMHC visits before and after INVEGA TRINZA initiation per year, 12 vs 6). Other measures such as ED admission, hospitalization per year, and number of hospitalization days were unchanged for most patients before and after initiation of INVEGA TRINZA. INVEGA TRINZA vs INVEGA SUSTENNA: No significant differences in ED admission (aOR [95% CI]: 1.18 [0.64-2.18]), hospitalization (aOR [95% CI]: 0.65 [0.32-1.34]), and hospitalization length (aOR [95% CI]: 0.76 [0.14-3.83]) were observed in patients using INVEGA SUSTENNA for 12±2 months before switching to INVEGA TRINZA vs patients who continued to be treated with INVEGA SUSTENNA. Conclusion: Transition to INVEGA TRINZA resulted in decreased CMHC visits per year after initiation of INVEGA TRINZA. No significant differences in HRU measures were observed between the INVEGA TRINZA and INVEGA SUSTENNA groups.
Abbreviations: aOR, adjusted odds ratio; AP, antipsychotic; ADR, adverse drug reaction; CI, confidence interval; CMHC, Community Mental Health Center; ED, emergency department; EHR, electronic health record; ER, emergency room; HRU, healthcare resource utilization; MPR, medication possession ratio; $NT, New Taiwan Dollar; OR, odds ratio; PDC, proportion of days covered; SD, standard deviation; VHA, Veterans Health Administration.^a4^th quarter defined as 1-3 months prior to INVEGA TRINZA initiation; 1^st quarter defined as 10-12 months prior to INVEGA TRINZA initiation.

Post Hoc Analysis of Health Resource Use and Cost of the Relapse Prevention Study and the Noninferiority Study

A comparison of HRU, costs, and occupational status was conducted between treatment groups in clinical trials 3012 (INVEGA TRINZA vs placebo) and 3011 (INVEGA TRINZA vs INVEGA SUSTENNA), in which both utilized the Healthcare Resource Use Questionnaire (HRUQ). Outcomes of these studies are summarized in Table: Post Hoc Analysis of Health Resource Use and Cost of the Relapse Prevention Study and the Noninferiority Study.

Post Hoc Analysis of HRU

Chirila et al (2017)² conducted a comparison of HRU between clinical trials 3012 (INVEGA TRINZA and PBO) and 3011 (INVEGA TRINZA and INVEGA SUSTENNA), in which both utilized the HRUQ. Sample Size: Clinical trial 3012: N=305 (INVEGA TRINZA: n=160; PBO: n=145); Clinical trial 3011: N=995 (INVEGA TRINZA: n=483; INVEGA SUSTENNA: n=512) Outcomes: *Clinical Trial 3012* HRU: The odds of a hospitalization for psychiatric and social reasons during 1 year was significantly higher for subjects who received PBO than those who received INVEGA TRINZA (OR [95% CI]: 7.74 [2.39-25.05]; P<0.001). The odds of a hospitalization for psychiatric reasons only was significantly higher for subjects who received PBO than those who received INVEGA TRINZA (OR [95% CI]): 6.72 [1.72-26.18]; P=0.006). *Clinical Trial 3011* HRU: The adjusted estimated probability of a hospitalization due to psychiatric and social reasons during 1 year was low in both the INVEGA SUSTENNA and INVEGA TRINZA treatment groups, with similar results observed for hospitalizations due to psychiatric reasons only. The difference between treatment groups was not statistically significant. The odds of a hospitalization for psychiatric and social reasons: OR (95% CI): 1.16 (0.70-1.93); P=0.557. The odds of a hospitalization for psychiatric reasons only: OR (95% CI): 1.63 (0.88-3.02); P=0.123. Conclusion: In trial 3012, there were significantly higher odds of hospitalization due to psychiatric or social reasons in the PBO group vs the INVEGA TRINZA group during the DB phase. In trial 3011, the odds of hospitalizations due to social or psychiatric reasons were not significantly different between INVEGA TRINZA and INVEGA SUSTENNA treatment groups
Abbreviations: CI, confidence interval; DB, double-blind; HRU, healthcare resource utilization; HRUQ, Healthcare Resource Use Questionnaire; OR, odds ratio; PBO, placebo.

Chirila et al (2017)² conducted a comparison of HRU between clinical trials 3012 (INVEGA TRINZA and PBO) and 3011 (INVEGA TRINZA and INVEGA SUSTENNA), in which both utilized the HRUQ.
Sample Size: Clinical trial 3012: N=305 (INVEGA TRINZA: n=160; PBO: n=145); Clinical trial 3011: N=995 (INVEGA TRINZA: n=483; INVEGA SUSTENNA: n=512)
Outcomes:
Clinical Trial 3012
HRU:

The odds of a hospitalization for psychiatric and social reasons during 1 year was significantly higher for subjects who received PBO than those who received INVEGA TRINZA (OR [95% CI]: 7.74 [2.39-25.05]; P<0.001).
The odds of a hospitalization for psychiatric reasons only was significantly higher for subjects who received PBO than those who received INVEGA TRINZA (OR [95% CI]): 6.72 [1.72-26.18]; P=0.006).

Clinical Trial 3011
HRU:

The adjusted estimated probability of a hospitalization due to psychiatric and social reasons during 1 year was low in both the INVEGA SUSTENNA and INVEGA TRINZA treatment groups, with similar results observed for hospitalizations due to psychiatric reasons only. The difference between treatment groups was not statistically significant.
- The odds of a hospitalization for psychiatric and social reasons: OR (95% CI): 1.16 (0.70-1.93); P=0.557.
- The odds of a hospitalization for psychiatric reasons only: OR (95% CI): 1.63 (0.88-3.02); P=0.123.

Conclusion: In trial 3012, there were significantly higher odds of hospitalization due to psychiatric or social reasons in the PBO group vs the INVEGA TRINZA group during the DB phase. In trial 3011, the odds of hospitalizations due to social or psychiatric reasons were not significantly different between INVEGA TRINZA and INVEGA SUSTENNA treatment groups

Abbreviations: CI, confidence interval; DB, double-blind; HRU, healthcare resource utilization; HRUQ, Healthcare Resource Use Questionnaire; OR, odds ratio; PBO, placebo.

LITERATURE SEARCH

A literature search of MEDLINE^®, EMBASE^®, BIOSIS Previews^®, DERWENT Drug File (and/or other resources, including internal/external databases) pertaining to this topic was conducted on 20 January 2025.

Health economic modeling, cost-effectiveness analyses using quality-adjusted life-year (QALYs) or health economic assessment questionnaires, review articles and studies focusing on adherence have not been included in this response.

References

Show

1	Gopal S, Vermeulen A, Nandy P, et al. Practical guidance for dosing and switching from paliperidone palmitate 1 monthly to 3 monthly formulation in schizophrenia. Curr Med Res Opin. 2015;31(11):2043-2054.
2	Chirila C, Nuamah I, Woodruff K. Health care resource use analysis of paliperidone palmitate 3 month injection from two phase 3 clinical trials. Curr Med Res Opin. 2017;33(6):1083-1090.
3	Emond B, Joshi K, Khoury ACE, et al. Adherence, healthcare resource utilization, and costs in Medicaid beneficiaries with schizophrenia transitioning from once-monthly to once-every-3-months paliperidone palmitate. Pharmacoecon Open. 2019;3(2):177-188.
4	Lin D, Pilon D, Zhdanava M, et al. 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. Curr Med Res Opin. 2021;37(4):675-683.
5	Patel C, El Khoury A, Huang A, et al. 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. Adv Ther. 2019;36(10):2941-2953.
6	El Khoury AC, Patel C, Mavros P, et al. Transitioning from once-monthly to once-every-3-months paliperidone palmitate among veterans with schizophrenia. Neuropsychiatr Dis Treat. 2021;17:3159-3170.
7	Emond B, El Khoury AC, Patel C, et al. Real-world outcomes post-transition to once-every-3-months paliperidone palmitate in patients with schizophrenia within US commercial plans. Curr Med Res Opin. 2019;35(3):407-416.
8	Dickson MC, Nguyen MM, Patel C, et al. Adherence, persistence, readmissions, and costs in Medicaid members with schizophrenia or schizoaffective disorder initiating paliperidone palmitate versus switching oral antipsychotics: a real-world retrospective investigation. Adv Ther. 2023;40(1):349-366.
9	Morrison L, Lin D, Benson C, et al. Projecting the economic outcomes of switching patients with schizophrenia from oral atypical antipsychotics to once-monthly, once-every-3-months, and once-every-6-months paliperidone palmitate. J Manag Care Spec Pharm. 2023;29(2):161-171.
10	Gilligan AM, El Khoury AC, Joshi K, et al. Treatment patterns in schizophrenia patients initiated on paliperidone palmitate long-acting injectable in a Medicaid population. Poster presented at: The American Psychiatric Association Congress Annual Meeting; May 5-9, 2018; New York City, NY.
11	Chang BC, Kuo MH, Lee CH, et al. Health-care utilisation and costs of transition from paliperidone palmitate 1-monthly to 3-monthly treatment for schizophrenia: a real-world, retrospective, 24-month mirror-image study. Neuropsychiatr Dis Treat. 2024;20(0):1985-1993.
12	DerSarkissian M, Lefebvre P, Joshi K, et al. Health care resource utilization and costs associated with transitioning to 3-month paliperidone palmitate among US veterans. Clin Ther. 2018;40(9):1496-1508.
13	Joshi K, Lafeuille MH, Brown B, et al. Baseline characteristics and treatment patterns of patients with schizophrenia initiated on once-every-three-months paliperidone palmitate in a real-world setting. Curr Med Res Opin. 2017;33(10):1763-1772.
14	Cirnigliaro G, Battini V, Cafaro R, et al. Barriers to the use of three-month paliperidone palmitate formulation: a study from an Italian real-world setting. Expert Rev Neurother. 2023;23(11):1031-1039.