MODELING FACILITY-LEVEL ADOPTION OF SEQUENTIAL DRUG INNOVATIONS USING MIXTURE CURE MODELS: EVIDENCE FROM LONG-ACTING ANTIPSYCHOTICS
Author(s)
Chen-Han Chueh, Ph.D.1, SZUNIAN YANG, M.D., Ph.D.2, I-Ting Wang, Ph.D.3, Chan-Yu Liu, B.S.3, Yi-Wen Tsai, Ph.D.3.
1Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA, 2Department of Psychiatry, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan, 3Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University, Taipei, Taiwan.
1Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA, 2Department of Psychiatry, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan, 3Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University, Taipei, Taiwan.
OBJECTIVES: To examine how intrinsic facility-level market characteristics—specifically market scope, scale, and concentration—are associated with the adoption of second-generation long-acting injectable (LAI) antipsychotics for patients with schizophrenia.
METHODS: Using Taiwan’s National Health Insurance claims data, we identified three facility cohorts based on the reimbursement introduction of second-generation LAI antipsychotics in June 2004 (risperidone), March 2012 (paliperidone), and March 2018 (aripiprazole), and followed each cohort through December 2020. Mixture cure models were used to estimate adoption likelihood and time to adoption. Facility-level market characteristics included market scope (prior LAI use), internal market scale (schizophrenia visit volume and LAI prescribing proportion), and intra-facility market concentration, measured by the Herfindahl-Hirschman Index. Models adjusted for facility characteristics and patient demographics.
RESULTS: Prior LAI use was associated with a higher likelihood of adopting subsequent LAI antipsychotics (OR: 4.55, 95% CI: 1.38-14.97 for paliperidone; OR: 3.58, 95% CI: 1.04-12.32 for aripiprazole), but also with delayed adoption among facilities that ultimately adopted (HR: 0.22, 95% CI: 0.05-1.03 for risperidone; HR: 0.26, 95% CI: 0.08-0.83 for paliperidone). Greater internal market scale was associated with a higher likelihood of adopting risperidone (OR: 2.07, 95% CI: 1.01-4.26) and faster adoption of later-generation agents, paliperidone (HR: 1.71, 95% CI: 1.00-2.92) and aripiprazole (HR: 1.03, 95% CI: 1.01-1.05). Higher intra-facility market concentration of LAI was associated with a lower likelihood of adopting paliperidone (OR: 0.40, 95% CI: 0.16-1.01) and delayed adoption among adopters (HR: 0.58, 95% CI: 0.33-1.01), but was associated with faster adoption of aripiprazole (HR: 2.18, 95% CI: 1.15-4.14).
CONCLUSIONS: Intrinsic facility-level market characteristics influence both the likelihood and speed of adoption of second-generation LAIs, with differential effects between first-entry and subsequent drug entrants.
METHODS: Using Taiwan’s National Health Insurance claims data, we identified three facility cohorts based on the reimbursement introduction of second-generation LAI antipsychotics in June 2004 (risperidone), March 2012 (paliperidone), and March 2018 (aripiprazole), and followed each cohort through December 2020. Mixture cure models were used to estimate adoption likelihood and time to adoption. Facility-level market characteristics included market scope (prior LAI use), internal market scale (schizophrenia visit volume and LAI prescribing proportion), and intra-facility market concentration, measured by the Herfindahl-Hirschman Index. Models adjusted for facility characteristics and patient demographics.
RESULTS: Prior LAI use was associated with a higher likelihood of adopting subsequent LAI antipsychotics (OR: 4.55, 95% CI: 1.38-14.97 for paliperidone; OR: 3.58, 95% CI: 1.04-12.32 for aripiprazole), but also with delayed adoption among facilities that ultimately adopted (HR: 0.22, 95% CI: 0.05-1.03 for risperidone; HR: 0.26, 95% CI: 0.08-0.83 for paliperidone). Greater internal market scale was associated with a higher likelihood of adopting risperidone (OR: 2.07, 95% CI: 1.01-4.26) and faster adoption of later-generation agents, paliperidone (HR: 1.71, 95% CI: 1.00-2.92) and aripiprazole (HR: 1.03, 95% CI: 1.01-1.05). Higher intra-facility market concentration of LAI was associated with a lower likelihood of adopting paliperidone (OR: 0.40, 95% CI: 0.16-1.01) and delayed adoption among adopters (HR: 0.58, 95% CI: 0.33-1.01), but was associated with faster adoption of aripiprazole (HR: 2.18, 95% CI: 1.15-4.14).
CONCLUSIONS: Intrinsic facility-level market characteristics influence both the likelihood and speed of adoption of second-generation LAIs, with differential effects between first-entry and subsequent drug entrants.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HSD108
Topic
Health Service Delivery & Process of Care