Cost-effectiveness model of long-acting risperidone in schizophrenia in the US.
ABSTRACT 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Published medical literature, unpublished data from clinical trials and a consumer health database, and a clinical expert panel were used to populate a decision-analysis model comparing the four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.
Article: Management of Schizophrenia[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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ABSTRACT: Complex modeling techniques such as discrete-event simulation and simpler Markov or decision-tree models have been used to estimate the cost-effectiveness of treatment for chronic diseases such as schizophrenia. A systematic literature review of MEDLINE, EconLit, Embase, and the Cochrane Library identified schizophrenia modeling studies presenting incremental cost-effectiveness ratios. The relationship between modeling technique used and reported outcomes was examined. Fifty-four studies reporting results of 69 pairs of drug comparisons were identified. Of the paired-drug comparisons, 27 were conducted in at least two studies; in 14 of the 27, the results agreed (i.e., drug A cost-effective compared with drug B) despite differences in modeling techniques. Thirteen of the 27 paired-drug comparisons had contradictory study results even when the same modeling technique was used. Different modeling techniques did not appear to explain different findings about cost-effectiveness.Expert Review of Pharmacoeconomics & Outcomes Research 02/2014; DOI:10.1586/14737167.2014.891443 · 1.87 Impact Factor
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ABSTRACT: OBJECTIVE The authors compared the efficacy of long-acting injectable antipsychotics and oral antipsychotics on rehospitalization rate of community-dwelling patients with schizophrenia who had frequent admissions. METHODS The cohort study of 14,610 patients was conducted by analyzing the Taiwan National Health Research Institutes data. The patients were divided into groups that received oral antipsychotics (risperidone, a different second-generation antipsychotic, or a first-generation antipsychotic) or long-acting injectable antipsychotics (risperidone, haloperidol, or flupenthixol). RESULTS One-year rehospitalization rates of the final cohort of 10,552 patients were the same for both groups (by long-acting injection, 27.3%; by oral administration, 27.3%). Secondary analysis of groups receiving long-acting injectable medication showed that haloperidol resulted in lower rehospitalization rates (haloperidol, 22.5%; risperidone, 27.1%; and flupenthixol, 29.5%). Patients' characteristics, including age, region, and insurance payments were significantly correlated with the risk of relapse (p<.05). CONCLUSIONS Except for injectable haloperidol, long-acting injectable antipsychotics seem not to be superior to oral antipsychotics in reducing rehospitalization.Psychiatric services (Washington, D.C.) 12/2013; 64(12):1259-62. DOI:10.1176/appi.ps.201200506 · 1.99 Impact Factor