Abstract/Summary

A number of naturalistic studies have investigated paliperidone palmitate using proxy measures of effectiveness. An unexplored option is to examine the utility of the mental health clustering tool, because it is used in UK clinical practice, measures patient wellbeing and is linked to allocation of resources. This study evaluated the effectiveness of paliperidone palmitate using the mental health clustering tool, the health of the nation outcome scales and, for comparison, more conventional outcome measures. This was a naturalistic, one-year evaluation of paliperidone palmitate (n = 50) in schizophrenia, alongside a comparator antipsychotic drug group. Changes in the mental health clustering tool ‘cluster-score cost ranking’ and four ‘health of the nation outcome scales-derived factors’ were analysed using a mixed model statistical analysis to explore the utility of these measures. At one year, 30 patients (60%) continued paliperidone palmitate treatment. The mean ‘cluster-score cost ranking’ (-1.5) and Severe Disturbance factor scores (-1.1) were significantly lower [p-value (adj) = 0.0003, p-value (adj) = 0.002, respectively] after one year of antipsychotic treatment but no differences were found between paliperidone palmitate and the comparator antipsychotic drug group. Patients prescribed paliperidone palmitate were 1.8 times (95% CI 1.1−3.1) more likely to be discharged from hospital than those in the comparator antipsychotic drug group. Paliperidone palmitate’s continuation rate after one year made the study similar to existing evaluations, and it was possible to prospectively evaluate antipsychotic effectiveness using the novel measures although these did not discriminate between paliperidone palmitate and the comparator group. The investigation illustrates that in principle these novel measures are meaningful in naturalistic study designs.