Abstract
INTRODUCTION: Literature comparing differences in efficacy of inpatient initiation of long-acting paliperidone palmitate once monthly (PP1M) and subcutaneous risperidone long acting-injectable (SC-RLAI) is currently limited and inconclusive. Differences in drug costs may guide choice of the preferred medication for inpatient formularies. In this study, we evaluated potential drug acquisition cost savings if PP1M initiations in the inpatient setting were replaced by SC-RLAI once monthly (SC-RLAI1M) at a single center where manufacturer programs and rebates are not used. METHODS: This was a single-center, retrospective, exploratory analysis examining dosages of oral risperidone prior to PP1M conversion and whether SC-RLAI1M could have been used based on dose equivalency. Single-center data from September 1, 2020, to February 29, 2024, were analyzed. The primary outcome was the predicted savings on drug costs based solely on U.S. dollars if each PP1M initiation was replaced with an equivalent SC-RLAI1M during the data period averaged on a yearly basis. RESULTS: Based on 45 total eligible initiations over the 3.5-year data-collection period and drug compendia available average wholesale prices, the use of SC-RLAI1M instead of PP1M would have translated to an average yearly hospital drug acquisition cost reduction of $49 257.37. Depending on the dose of SC-RLAI1M utilized in each instance, a reduction between $3111.63 and $5420.03 would have been observed per patient. DISCUSSION: Inpatient institutions may have an opportunity to decrease drug costs by switching from PP1M to SC-RLAI1M as a formulary-preferred medication when appropriate. However, administrators should consider institution-specific costs as well as product availability for patients after discharge.