Analyse coût-efficacité des stratégies de prise en charge des patients schizophrènes : place d’un antipsychotique atypique sous forme injectable à libération prolongée

Llorca, Pierre‐Michel; Miadi-Fargier, H; Lançon, Christophe; JassoMosqueda, G.; Casadebaig, F.; Philippe, Anne; Guillon, P.; Mehnert, A.; Omnes, Louis-François; Chicoye, A; Durand‐Zaleski, Isabelle

doi:10.1016/s0013-7006(05)82390-5

Cited by 39 publications

(8 citation statements)

References 10 publications

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“…Several health economic models in schizophrenia have been developed [ 28 , 29 , 63 , 64 ], but only one study assessing the cost effectiveness of different antipsychotics in France has been identified [ 30 ]. In 2005, Llorca et al [ 25 ] evaluated the impact in terms of medical benefits and costs of risperidone LAI, haloperidol LAI or oral olanzapine over a 2-year time horizon. To consider the advantages of LAIs (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…1 , 2 These included paliperidone LAI, risperidone LAI, aripiprazole LAI, olanzapine LAI, haloperidol LAI and oral olanzapine. Costs, quality-adjusted life-years (QALYs) gained and relapses avoided were assessed and compared for each of these compounds over a time horizon of 5 years at a discount rate of 4 %, from a French statutory health insurance perspective (‘Assurance Maladie’ [ 25 ]).…”

Section: Methodsmentioning

confidence: 99%

“…The hospitalisation rate from the CGS was chosen to estimate the relapse rate based on the conclusion from Olivares et al [ 45 ], who demonstrated that hospitalisation was the most frequently used factor to track the incidence of relapse. In the CGS, the annual risk of hospitalisation, readjusted for treatment effects and hospitalisation history associated with risperidone LAI, was 19.43 % 5 (assuming two-thirds of relapsing patients were hospitalised 6 [ 25 , 28 ], resulting in an annual risk of relapse of 29.15 %). Thus, the 3-monthly risk of relapse for patients treated with risperidone LAI was estimated at 8.25 % in the model.…”

Section: Methodsmentioning

confidence: 99%

“…Few economic studies have been conducted in France assessing either the costs associated with schizophrenia or the benefit/costs ratio of antipsychotics [ 24 , 25 ]. In 2005, a French study comparing three antipsychotics established superiority with LAI risperidone compared with LAI haloperidol and oral olanzapine [ 25 ]. Since 2005, three LAI antipsychotics have received a European marketing authorisation (MA): olanzapine LAI (Zypadhera ® , MA in 2008), paliperidone LAI (Xeplion ® , MA in 2011) and aripiprazole LAI (Abilify Maintena ® , MA in 2013).…”

Section: Introductionmentioning

confidence: 99%

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Cost Effectiveness of Paliperidone Long-Acting Injectable Versus Other Antipsychotics for the Maintenance Treatment of Schizophrenia in France

Druais¹,

Doutriaux

Cognet

et al. 2016

PharmacoEconomics

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BackgroundFrench clinical recommendations suggest prescribing long-acting injectable (LAI) antipsychotics to patients with a maintenance treatment indication in schizophrenia. Despite this, and due to their relatively high acquisition and administration costs, LAIs are still underused in clinical practice in France, thus highlighting the need for pharmacoeconomic evaluations.ObjectiveOur objective was to estimate the cost effectiveness of paliperidone LAI (or paliperidone palmitate), a once-monthly second-generation LAI antipsychotic, compared with the most common antipsychotic medications for the maintenance treatment of schizophrenia in France.MethodsA Markov model was developed to simulate the progression of a cohort of schizophrenic patients through four health states (stable treated, stable non-treated, relapse and death) and to consider up to three lines of treatment to account for changes in treatment management. Paliperidone LAI was compared with risperidone LAI, aripiprazole LAI, olanzapine LAI, haloperidol LAI (or haloperidol decanoate) and oral olanzapine. Costs, quality-adjusted life-years (QALYs) and number of relapses were assessed over 5 years based on 3-month cycles with a discount rate of 4 % and from a French health insurance perspective. Patients were considered to be stabilised after a schizophrenic episode and would enter the model at an initiation phase, followed by a prevention of relapse phase if successful. Data (e.g. relapse or discontinuation rates) for the initiation phase came from randomised clinical trials, whereas relapse rates in the prevention phase were derived from hospitalisation risks based on real-life French data to capture adherence effects. Safety and utility data were derived from international publications. Additionally, costs were retrieved from French health insurance databases and publications. Finally, expert opinion was used for validation purposes or in case of gaps in data. The robustness of results was assessed through deterministic and probabilistic sensitivity analyses.ResultsAll LAI antipsychotics were found to have similar costs over 5 years: approximatively €55,000, except for paliperidone LAI which had a discounted cost of €50,880. Oral olanzapine was less costly than LAIs (i.e. €50,379 after 5 years) but was associated with fewer QALYs gained and relapses avoided. Paliperidone LAI dominated aripiprazole LAI, olanzapine LAI and haloperidol LAI in terms of costs per QALY, and it was associated with slightly fewer QALYs when compared with risperidone LAI (i.e. 3.763 vs 3.764). This resulted in a high incremental cost-effectiveness ratio (ICER) (i.e. €4,770,018 per QALY gained) for risperidone LAI compared with paliperidone LAI. Paliperidone LAI was more costly than olanzapine oral but associated with more QALYs (i.e. ICER of €2411 per QALY gained for paliperidone LAI compared with oral olanzapine). Paliperidone LAI had a probability of being the optimal strategy in more than 50 % of cases for a willingness-to-pay threshold of €8000 per QALY gained.Conclusion...

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cost Effectiveness of Paliperidone Long-Acting Injectable Versus Other Antipsychotics for the Maintenance Treatment of Schizophrenia in France

Druais¹,

Doutriaux

Cognet

et al. 2016

PharmacoEconomics

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“…Public care included local Centres Médicale Psychiatriques (CMP) offering semiannual consultations with a psychiatrist as well as daily supported activities; and Hôpitaux de Jours (Day Hospitals). With the general lack of social housing in France, living with the family was common for many PWS [33] [34]. Following up on this initial study, the present study applied a medical anthropological approach to further explore the patients' experiences with SZ in their differing socio-cultural environments.…”

Section: Introductionmentioning

confidence: 99%

Social Aspects of the Quality of Life of Persons Suffering from Schizophrenia

Mortensen¹,

De²,

Holme³

et al. 2016

OJPsych

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Background: Several studies have shown that persons with schizophrenia (PWS) suffer from severely reduced quality of life (QoL). Impaired social functioning is a defining characteristic of schizophrenia (SZ) and social cognition deficits affect interpersonal relations and outcomes such as independent living, vocational functioning and employment status. Some studies have demonstrated important socio-cultural aspects of SZ, for instance by examining experiences of SZ in different developing countries and among minority groups in the Western world. The socio-cultural context is central to understanding patients' experiences in any society, however. Using an anthropological approach, we use qualitative research methods to examine patient perspectives on SZ. Sampling and Methods: In-depth qualitative interviews are carried out with SZ patients in France, the UK and the USA representing diversity in Western mental health systems. Results: To the participants, the most important QoL aspects are close relations and support from loved ones, a safe home and comfort zone, and meaningful daily activities. Normalisation and independence act as central themes to patients' QoL and hopes for social integration. The participants need a buffer zone consisting of social relations, a home and daily occupation that is flexible and may balance issues of equality/inequality, abnormality/normality, and dependence/independence. Conclusion: By using participatory methods, PWS may be involved in shaping their own treatment and recovery plans based on what is subjectively meaningful and beneficial to their mental health. QoL and functioning are closely linked to the socio-cultural context in which health care structures go hand in hand with health care cultures that shape patients' expectations and preferences.

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