Paliperidone palmitate (PP) is a long acting depot antipsychotic that received marketing authorisation in the UK in 2011. It is costly compared to first generation antipsychotics (FGAs) and there are no robust trials comparing PP with FGAs. We examined the effectiveness and use of PP in a mental health trust as well as the characteristics of patients prescribed PP.

We identified all patients prescribed PP in North Staffordshire (population 470 000) since launch and examined records for demography, diagnosis, bed and medication use. We examined the effectiveness of PP using a mirror image design with bed use as the primary outcome.

52 patients received PP in a time frame allowing a one year follow up. 58% were male and the mean age was 41 years. Over half were detained under the 1983 Mental Health Act. 51 patients had a psychotic diagnosis. There was a significant reduction in bed occupancy (44 v 26 days, P=0.018) and admissions (1.1 v 0.2, P=0.0001). The mean dose was 100mg. Lack of effectiveness was the primary reason for starting PP in 84%. Two patients stopped due to side effects and 26% due to lack of efficacy.

Within the limitations of the methodology our results show a reduction in psychiatric bed use in the year following PP initiation on an intention to treat basis. The reduction in bed use equates to a minimum saving of £5400 per patient. PP at the mean study dose costs £3769.