Cost-effectiveness of lurasidone vs aripiprazole among patients with schizophrenia who have previously failed on an atypical antipsychotic: an indirect comparison of outcomes from clinical trial data

Rajagopalan, Krithika; Hassan, Mariam; O’Day, Ken; Meyer, Kellie; Grossman, Fred

doi:10.3111/13696998.2013.807813

Cited by 11 publications

(42 citation statements)

References 42 publications

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“…Results of the base-case cost-effectiveness analyses showed that brexpiprazole was the dominant treatment strategy compared with lurasidone and cariprazine for all outcomes assessed. Although this is the only cost-effectiveness analysis of brexpiprazole compared to lurasidone and cariprazine we are aware of, the cost-effectiveness of lurasidone has been explored in previous studies; 36 – 38 however, these models included different populations, comparators, inputs, assumptions, and time horizons, making comparison across studies difficult. Model results should be considered in light of limitations.…”

Section: Discussionmentioning

confidence: 99%

Relapse prevention: a cost-effectiveness analysis of brexpiprazole treatment in adult patients with schizophrenia in the USA

Aigbogun¹,

Liu²,

Kamat³

et al. 2018

CEOR

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ObjectiveThis study used a decision-analytic framework to assess the cost-effectiveness of brexpiprazole vs comparator branded therapies for reducing relapses and hospitalizations among adults with schizophrenia from a US payer perspective.MethodsAn economic model was developed to assess patients with stable schizophrenia initiating treatment with brexpiprazole (1–4 mg), cariprazine (1–6 mg), or lurasidone (40–80 mg) over a 1-year period. After 6 months, patients remained on treatment or discontinued due to relapse, adverse events, or other reasons. Patients who discontinued due to relapse or adverse events were assumed to have switched to other therapy, and those who discontinued due to other reasons were assumed to have received no therapy. Primary outcomes were incremental cost per relapse avoided and hospitalization avoided, and the secondary outcome was cost per quality-adjusted life-year (QALY) gained. Sensitivity and scenario analyses were also conducted.ResultsBrexpiprazole was associated with the highest per-patient clinical effectiveness (avoided relapses 0.637, avoided hospitalizations 0.719, QALYs 0.707) among comparators, followed by cariprazine (avoided relapses 0.590, avoided hospitalizations 0.683, QALYs 0.683) and lurasidone (avoided relapses 0.400, avoided hospitalizations 0.536, QALYs 0.623). Annual per-patient health-care costs were lowest for brexpiprazole ($20,510), followed by cariprazine ($22,282) and lurasidone ($25,510). Brexpiprazole was the least costly and most effective treatment strategy for all outcomes. Results were sensitive to relapse rates and daily cost of brexpiprazole. Limitations include data principally obtained from drug-specific randomized withdrawal studies and lack of direct-comparison trials.ConclusionThis analysis evaluated brexpiprazole treatment for the reduction of schizophrenia relapses and hospitalizations over a 1-year period compared to other recently available branded antipsychotics, and excluded generic antipsychotic treatments. Brexpiprazole treatment may lead to clinical benefits and medical cost savings, and provides a cost-effective treatment option for patients relatively to other branded second-generation antipsychotics.

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Section: Discussionmentioning

confidence: 99%

Relapse prevention: a cost-effectiveness analysis of brexpiprazole treatment in adult patients with schizophrenia in the USA

Aigbogun¹,

Liu²,

Kamat³

et al. 2018

CEOR

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“…A similar study comparing lurasidone with aripiprazole for second-line use in patients with schizophrenia found lurasidone to be cost-effective 36. This is the first cost-effectiveness analysis comparing lurasidone with other AAPs for firstline use in patients with schizophrenia.…”

Section: Discussionmentioning

confidence: 78%

Long-term cost-effectiveness of atypical antipsychotics in the treatment of adults with schizophrenia in the US

O’Day¹,

Rajagopalan²,

Meyer³

et al. 2013

CEOR

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BackgroundThe purpose of this study was to evaluate the long-term cost-effectiveness (including hospitalizations and cardiometabolic consequences) of atypical antipsychotics among adults with schizophrenia.MethodsA 5-year Markov cohort cost-effectiveness model, from a US payer perspective, was developed to compare lurasidone, generic risperidone, generic olanzapine, generic ziprasidone, aripiprazole, and quetiapine extended-release. Health states included in the model were patients: on an initial atypical antipsychotic; switched to a second atypical antipsychotic; and on clozapine after failing a second atypical antipsychotic. Incremental cost-effectiveness ratios (ICERs) assessed incremental cost/hospitalization avoided. Effectiveness inputs included discontinuations, hospitalizations, weight change, and cholesterol change from comparative clinical trials for lurasidone and for aripiprazole, and the Clinical Antipsychotic Trials of Intervention Effectiveness for other comparators. Atypical antipsychotic-specific relative risk of diabetes obtained from a retrospective analysis was used to predict cardiometabolic events per Framingham body mass index risk equation. Mental health costs (relapsing versus nonrelapsing patients) and medical costs associated with cardiometabolic consequences (cardiovascular events and diabetes management) were obtained from published sources. Atypical antipsychotic costs were estimated from Red Book® prices at dose(s) reported in clinical data sources used in the model (weighted average dose of lurasidone and average dose for all other comparators). Costs and outcomes were discounted at 3%, and model robustness was tested using one-way and probabilistic sensitivity analyses.ResultsZiprasidone, olanzapine, quetiapine extended-release, and aripiprazole were dominated by other comparators and removed from the comparative analysis. ICER for lurasidone versus risperidone was $25,884/relapse-related hospitalization avoided. At a $50,000 willingness-to-pay threshold, lurasidone has an 86.5% probability of being cost-effective, followed by a 7.2% probability for olanzapine, and 6.3% for risperidone. One-way sensitivity analysis showed the model is sensitive to lurasidone and generic risperidone hospitalization rates.ConclusionGeneric risperidone is the least costly atypical antipsychotic. Lurasidone is more costly and more effective than risperidone and is cost-effective at willingness-to-pay thresholds of greater than $25,844 per hospitalization avoided. The favorable cost-effectiveness of lurasidone is driven by its clinical benefits (eg, efficacy in preventing hospitalizations in patients with schizophrenia) and its minimal cardiometabolic adverse effect profile.

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“…The data on economic evaluation were extracted on a spreadsheet preformatted in Microsoft Excel® by two independent authors (ICBH and TML), and any disagreement was resolved by a third author (PMA). The following data were extracted type of economic evaluation, type of population, country, payer's perspectives, reference [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] which fully met the eligibility criteria were selected for this systematic review (Figure 1).…”

Section: Data Extractionmentioning

confidence: 99%

“…Most of the studies have not established an age group of the target population, and four studies have focused on adult patients. 14,[19][20][21] In addition, none of the studies have established the definition of the age groups (eg 30-50 years). Eight studies specified the phase at which the patients with schizophrenia entered the study (eg remission, acute phase, right after the failure of antipsychotic therapy, hospitalization), [14][15][16][17]21,[28][29][30] and only one study has specified the onset age of the disease.…”

Section: Characteristics Of the Full Economic Evaluationsmentioning

confidence: 99%

Economic evaluations on the use of aripiprazole for patients with schizophrenia: A systematic review

et al. 2019

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What is known and objectives: Schizophrenia is a serious mental disorder and is associated with substantial economic and social burden. Cost-effectiveness analysis is important to assess the costs of different therapeutic options. However, there is a lack of information on the reporting quality of economic evaluations, cost drivers, as well as updated data focused on aripiprazole, an antipsychotic drug commonly prescribed in schizophrenia. This study evaluates and summarizes the evidence of economic evaluations of the use of aripiprazole in schizophrenia. In addition, we aimed to identify cost drivers and critically assess the reporting qualities of these studies. Methods: A comprehensive literature research was conducted using PubMed, NHS Economic Evaluation Database, CEA Registry and LILACS databases dated until March 2018. Full economic analyses of aripiprazole in schizophrenia that were based Identify the study as an economic evaluation or use more specific terms such as 'cost-effectiveness analysis', and describe the interventions compared 8 (47.0%

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Cost-effectiveness of lurasidone vs aripiprazole among patients with schizophrenia who have previously failed on an atypical antipsychotic: an indirect comparison of outcomes from clinical trial data

Abstract: Based on this model, when switching from another atypical antipsychotic, lurasidone had fewer relapses and hospitalizations with a lower incidence of diabetes and CV events than aripiprazole. Additionally, lurasidone may be less costly than aripiprazole among adults with schizophrenia.

Cited by 11 publications

References 42 publications

Relapse prevention: a cost-effectiveness analysis of brexpiprazole treatment in adult patients with schizophrenia in the USA

Relapse prevention: a cost-effectiveness analysis of brexpiprazole treatment in adult patients with schizophrenia in the USA

Long-term cost-effectiveness of atypical antipsychotics in the treatment of adults with schizophrenia in the US

Economic evaluations on the use of aripiprazole for patients with schizophrenia: A systematic review

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