Cost-effectiveness analysis of atypical long-acting antipsychotics for treating chronic schizophrenia in Finland

Einarson, Thomas R.; Pudas, Hanna; Zilbershtein, Roman; Jensen, R.; Vicente, Colin; Piwko, Charles; Hemels, M.

doi:10.3111/13696998.2013.823869

Cited by 14 publications

(6 citation statements)

References 44 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.…”

Section: Discussionmentioning

confidence: 99%

“…Six analyses assessing the cost effectiveness of paliperidone LAI have been identified in other countries: Mehnert et al [ 28 ] in Sweden, Zeidler et al [ 29 ] in Germany, Kolek et al [ 64 ] in the Czech Republic, Einarson et al [ 63 ] in Finland, Citrome et al [ 65 ] in the USA and Lee et al in Wales [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…The Finnish study assessed paliperidone LAI, risperidone LAI and olanzapine LAI in patients switched to LAI antipsychotics due to compliance issues with previous treatments [ 63 ]. At the 1-year time horizon, paliperidone LAI was associated with better outcomes and was less costly than risperidone LAI and olanzapine LAI.…”

Section: Discussionmentioning

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: Discussionmentioning

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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“…This model was a decision tree comparing the 1-year economic consequence of 3-line antipsychotic treatment sequences. It was selected according to the following reasons: 1) its structure was widely used with eight adaptations [17][18][19][20][21][22][23][24]; 2) it did not consider utility values for the health states other than schizophrenia, such as treatmentrelated side effects; 3) it was a simple model requiring fewer interpretations to replicate the model. Our analysis only compared olanzapine long-acting injection (LAI) with risperidone LAI as a first-line treatment, since this comparison generated non-dominance ICER results in Einarson et al [17].…”

Section: Methodsmentioning

confidence: 99%

Systematic review of utility values used in the pharmacoeconomic evaluations for schizophrenia: implications on cost-effectiveness results

Zhou

Millier

François

et al. 2019

Journal of Market Access & Health Policy

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Background and Objectives: Utility elicitation studies for schizophrenia generate different utility values for the same health states. We reviewed utility values used in schizophrenia pharmacoeconomic evaluations and evaluated the impact of their selection on the incremental costeffectiveness ratio (ICER). Methods: A systematic search was performed in Medline and Embase. Health state definitions, associated utility values, elicitation studies, and value selection processes were extracted. Sets of utility values for all schizophrenia health states were used in a cost-effectiveness model to evaluate the ICER. Results: Thirty-five cost-utility analyses (CUAs) referring to 11 utility elicitation studies were included. The most frequent health states were 'stable' (28 CUAs, 7 utility elicitation studies, 10 values, value range 0.650-0.919), 'relapse requiring hospitalisation' (18, 5, 7, 0.270-0.604), 'relapse not requiring hospitalisation' (18, 5, 10, 0.460-0.762), and 'relapse only' (10, 5, 6, 0.498-0.700). Seventeen sets of utility values were identified with difference in utility values between relapse and stable ranging from −0.358 to −0.050, resulting in ICERs ranging from −56.2% to +222.6% from average. Conclusion: The use of utility values for schizophrenia health states differs among CUAs and impacts on the ICER. More rigorous and transparent use of utility values and sensitivity analysis with different sets of utility values are suggested for future CUAs.

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“…PP1M is the most cost-effective treatment compared to oral SGAPs or FG-LAIAs ( 47 ). In a study conducted on the basis of Finnish national health data, PP1M treatment was found to be cost-effective in schizophrenia compared to LAI-olanzapine and LAI-risperidone treatments, with a lower hospitalization rate, fewer emergency room admissions and less relapse ( 48 ). PP3M provided advantages in both cost-effectiveness and cost-benefit analyzes, with lower relapses, fewer hospitalizations and fewer emergency room admissions compared to PP1M, LAI-haloperidol, LAI-risperidone and oral olanzapine ( 49 ).…”

Section: Use Of Long Acting Injectable Antipsychotics In Schizophreniamentioning

confidence: 99%

Depot/Long Acting Antipsychotics in the Treatment of Schizophrenia and Bipolar Disorder

Özgüven¹,

Kır²

2021

Archives of Neuropsychiatry

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Schizophrenia and bipolar disorder (BD) are psychiatric disorders with economic and social effects that cause disability. Treatment non-compliance is one of the major problems faced by clinicians in both schizophrenia and BD. Treatment non-compliance is associated with recurrence and impaired functionality. Treatment compliance increases with long-acting injectable antipsychotics (LAIAs) and recurrence times are prolonged, hospitalization rates decrease compared to those who use an equivalent oral form of the same drug. The use of LAIAs in the maintenance treatment of schizophrenia has also been associated with a low mortality rate, decrease in caregiver burden, and increase in patient satisfaction. Studies show that LAIAs are cost-effective compared to their oral forms. Data on the use of LAIAs in first-episode schizophrenia and BD are relatively limited. The results of studies on the use of LAIAs in patients with first-episode schizophrenia indicate that LAIAs have advantageous in preventing relapse and re-hospitalization compared to oral antipsychotics. In BD, with the use of LAIAs, the rate of hospitalization due to mood episodes and the frequency of manic episodes have been decreased. LAIAs have not been found to be as effective in preventing depressive episodes in BD as manic episodes. Although there are many studies supporting the use of LAIAs in maintenance treatment of schizophrenia and BD, more studies are needed on this issue. In this article, studies on the use of LAIAs in schizophrenia, first episode schizophrenia and BD are reviewed and the place of LAIAs in treatment was discussed.

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Cost-effectiveness analysis of atypical long-acting antipsychotics for treating chronic schizophrenia in Finland

Abstract: In Finland, PP-LAI dominated the other LAIs as it was associated with a lower cost and better clinical outcomes.

Cited by 14 publications

References 44 publications

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

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

Systematic review of utility values used in the pharmacoeconomic evaluations for schizophrenia: implications on cost-effectiveness results

Depot/Long Acting Antipsychotics in the Treatment of Schizophrenia and Bipolar Disorder

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