Long-acting risperidone compared with oral olanzapine and haloperidol depot in schizophrenia: a Belgian cost-effectiveness analysis

Abstract

Patients with schizophrenia suffer numerous relapses and rehospitalizations that are associated with high direct and indirect medical expense. Suboptimal therapeutic efficacy and, in particular, problems with compliance are major factors leading to relapse. Atypical antipsychotic agents offer improved efficacy and a lower rate of extrapyramidal adverse effects compared with conventional antipsychotic drugs. Long-acting intramuscular risperidone combines these benefits with improvements in compliance associated with depot injections. To assist decision making regarding the place of long-acting risperidone in therapy, a cost-effectiveness analysis of strategies involving first-line treatment with long-acting risperidone, oral olanzapine or depot haloperidol was performed from the perspective of the Belgian healthcare system. A decision tree model was created to compare the cost effectiveness of three first-line treatment strategies in a sample of young schizophrenic patients who had been treated for 1 year and whose disease had not been diagnosed for longer than 5 years. The model used a time horizon of 2 years, with health state transition probabilities, resource use and cost estimates derived from clinical trials, expert opinion and published prices. The four health states in the model were derived from an analysis of the literature. The principal efficacy measure was the proportion of patients successfully treated, defined as those who responded to initial treatment and who had none to two episodes of clinical deterioration without needing a change of treatment over the 2-year period. Comprehensive sensitivity analysis was carried out to test the robustness of the model. A greater proportion of patients were successfully treated with long-acting risperidone (82.7%) for 2 years, compared with those treated with olanzapine (74.8%) or haloperidol (57.3%). Total mean costs per patient over 2 years were 16,406 Euro with long-acting risperidone, 17,074 Euro with olanzapine and 21,779 Euro with haloperidol (year of costing 2003). The mean cost-effectiveness ratios were 19,839 Euro, 22,826 Euro and 38,008 Euro per successfully treated patient for long-acting risperidone, olanzapine and haloperidol, respectively. Results of the sensitivity analysis confirmed that the results were robust to a wide variation of different input variables (effectiveness, dosing distribution, patient status according to healthcare system). Long-acting risperidone was the dominant strategy, being both more effective and less costly than either oral olanzapine or depot haloperidol. Long-acting risperidone appears to represent a favourable first-line strategy for patients with schizophrenia requiring long-term maintenance treatment.

“Breakthrough” Dopamine Supersensitivity during Ongoing Antipsychotic Treatment Leads to Treatment Failure over Time

“…However, a notable proportion of initially stabilized patients relapse during treatment and this cannot always be explained by nonadherence to treatment. For example, even when medication is guaranteed by depot injection, the average relapse rate at 1-2 years is still 18 -55% (Carpenter et al, 1999;Schooler, 2003;De Graeve et al, 2005). Although relapse during continued treatment can be attributed to a number of reasons, our results suggest that an antipsychotic-induced increase in dopamine sensitivity might predispose certain individuals to psychotic relapse.…”

Long-acting risperidone injection: efficacy, safety, and cost-effectiveness of the first long-acting atypical antipsychotic

“…A number of studies have employed either discrete event simulation or decision analytic models, both of which theoretically address the heterogeneous and real-world characteristics of patients with schizophrenia, to examine the costs of long-acting risperidone compared with oral and conventional long-acting agents in the US, Canada, Belgium, and Germany (Chue et al 2005c; De Graeve et al 2005; Edwards et al 2005; Laux et al 2005). …”

“…In the Belgian model, a decision tree model was created to compare the cost effectiveness of three first-line treatment strategies in a sample of young schizophrenia patients who had been treated for 1 year and whose disease had not been diagnosed for longer than 5 years (De Graeve et al 2005). This model used a time horizon of 2 years, with health state transition probabilities, resource use and cost estimates derived from clinical trials, expert opinion, and published prices.…”

Cost-Effectiveness Analysis of Switching Antipsychotic Medication to Long-Acting Injectable Risperidone in Patients with Schizophrenia

“…[8][9][10] Atypical antipsychotic agents have ses using pharmacoeconomic models have consistbeen found to delay the occurrence of psychotic ently shown that long-acting injectable risperidone episodes more effectively than the first-generation reduces relapses and is, thereby, cost saving. [30][31][32][33][34][35][36][37] conventional drugs such as haloperidol and…”

“…effectiveness treatment option of long-acting injectAlthough it is standard practice in pharmacoable risperidone has been confirmed in other studeconomic studies to provide comparisons with alteries. [30][31][32][33][34][35][36]43,44] native treatments during the same period, no such The individual and societal burden associated comparison was made in this analysis. The use of with the disorder is very high in terms of mortality, the same patient as a control itself allowed us to morbidity, and economic and social costs.…”