Schizophrenia is a devastating and costly illness that affects 1% of the population in the US. Effective pharmacological therapies are available but suboptimal patient adherence to either acute or long-term therapeutic regimens reduces their effectiveness. The availability of a long-acting injection (LAI) formulation of risperidone may increase adherence and improve clinical and economic outcomes for people with schizophrenia.
To assess the cost effectiveness of risperidone LAI compared with oral risperidone, oral olanzapine and haloperidol decanoate LAI over a 1-year time period in outpatients with schizophrenia who had previously suffered a relapse requiring hospitalisation.
US healthcare system.
Published medical literature, unpublished data from clinical trials and a consumer health database, and a clinical expert panel were used to populate a decision-analysis model comparing the four treatment alternatives. The model captured: rates of patient compliance; rates, frequency and duration of relapse; incidence of adverse events (bodyweight gain and extrapyramidal effects); and healthcare resource utilisation and associated costs. Primary outcomes were: the proportion of patients with relapse; the frequency of relapse per patient; the number of relapse days per patient; and total direct medical cost per patient per year. Costs are in year 2002 US dollars.
Based on model projections, the proportions of patients experiencing a relapse requiring hospitalisation after 1 year of treatment were 66% for haloperidol decanoate LAI, 41% for oral risperidone and oral olanzapine and 26% for risperidone LAI, while the proportion of patients with a relapse not requiring hospitalisation were 60%, 37%, 37% and 24%, respectively. The mean number of days of relapse requiring hospitalisation per patient per year was 28 for haloperidol decanoate LAI, 18 for oral risperidone and oral olanzapine and 11 for risperidone LAI, while the mean number of days of relapse not requiring hospitalisation was 8, 5, 5 and 3, respectively. This would translate into direct medical cost savings with risperidone LAI compared with oral risperidone, oral olanzapine and haloperidol decanoate LAI of USD 397, USD 1742, and USD 8328, respectively. These findings were supported by sensitivity analyses.
The use of risperidone LAI for treatment of outpatients with schizophrenia is predicted in this model to result in better clinical outcomes and lower total healthcare costs over 1 year than its comparators, oral risperidone, oral olanzapine and haloperidol decanoate LAI. Risperidone LAI may therefore be a cost saving therapeutic option for outpatients with schizophrenia in the US healthcare setting.
[Show abstract][Hide abstract] ABSTRACT: Introduction
The aim of this study was to assess the cost-effectiveness of long-acting risperidone versus oral risperidone, oral olanzapine and haloperidol decanoate in the treatment of schizophrenia.
We used a pre-existent model in which four cohorts of patients with schizophrenia received an antipsychotic treatment (either long-acting risperidone or oral risperidone or oral olanzapine or haloperidol decanoate). The model observed the patients for 12 months. The analysis was carried out from the perspective of the Italian National Health Service. The study considered percentage of patients experiencing relapse, mean number of relapses, mean number of days of relapse, mean number of stable days per patient and direct medical costs. Sensitivity analysis on key clinical and economic parameters were performed.
Risperidone long-acting showed the best clinical outcomes versus the other three antipsychotic treatments. The expected cost was € 9,366 with long-acting risperidone, € 9,875 with oral risperidone, € 10,820 with oral olanzapine, and € 13,271 with haloperidol decanoate.
Discussion and conclusions
This cost-effectiveness analysis showed that long-acting risperidone is a dominant strategy compared with oral risperidone, oral olanzapine, and haloperidol decanoate in the treatment of schizophrenia.
PharmacoEconomics - Italian Research Articles 01/2013; 8(1). DOI:10.1007/BF03320555 · 3.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Schizophrenia is a chronic disease that typically manifests during adolescence and early adulthood. Treatment of this disease consumes a significant proportion of the healthcare budget (billions of dollars in the US). Primary management options for schizophrenia include both pharmacologic and psychosocial interventions, with antipsychotic therapy (typicals or atypicals) being the mainstay of any treatment plan. Atypical agents are recommended in current guidelines as first-line treatments for patients with newly diagnosed schizophrenia. The newer atypical antipsychotic agents have a lower propensity to cause extrapyramidal symptoms and tardive dyskinesia, and are at least as effective as typical agents.
Long-acting injectable formulations of antipsychotic drugs help to ensure drug delivery and are recommended in patients who are partially or fully noncompliant, or who prefer this formulation. The goal of using these agents is to reduce noncompliance, thus reducing the likelihood of relapse and/or hospitalization, and ultimately reducing treatment costs. Benefits associated with long-acting formulations include the maintenance of stable plasma concentrations, the reduction of overdose risks, and the establishment of regular contact between the patient and their healthcare provider. Currently, risperidone is the only atypical agent available as a long-acting injectable formulation.
In patients with schizophrenia, long-acting injectable risperidone (25–50mg every 2 weeks) is no less effective than once-daily oral risperidone, has superior efficacy to placebo over the short term, and significantly improves symptoms over the long term in patients who are symptomatically stable at baseline. Long-acting injectable risperidone is well tolerated and has a tolerability profile similar to that of oral risperidone, apart from injection-site reactions, which are generally mild and transient. This formulation of risperidone reduces the incidence of hospitalization and significantly improves health-related quality of life (HR-QOL; in particular mental health-related domains) in patients with symptomatically stable schizophrenia. Pharmacoeconomic models have indicated that long-acting injectable risperidone — relative to oral risperidone, oral olanzapine, or long-acting haloperidol — is associated with cost savings and is the dominant strategy in terms of cost effectiveness.
The efficacy and tolerability profile of long-acting injectable risperidone, its ability to reduce hospitalization rates and improve HR-QOL, and its demonstrated cost effectiveness in pharmacoeconomic models support the use of this agent in the management of schizophrenia.
Disease Management and Health Outcomes 01/2006; 14(2). DOI:10.2165/00115677-200614020-00006 · 0.35 Impact Factor
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