Costs and effects of long-acting risperidone compared with oral atypical and conventional depot formulations in Germany

Abstract

Schizophrenia is one of the most expensive psychiatric conditions because of high direct and indirect costs associated with the nature of the illness, its resistance to treatment and the consequences of relapse. Long-acting risperidone is a new formulation of an atypical antipsychotic drug that also offers the improvements in compliance associated with haloperidol depot. The aim of this simulation study was to compare the benefits and costs of three pharmacological treatment strategies comprising first-line treatment with long-acting risperidone injection, a haloperidol depot or an oral atypical antipsychotic agent, over a 5-year period in Germany. A discrete event simulation model was developed to compare three treatment scenarios from the perspective of major third-party payers (sickness funds and social security 'Sozialversicherung'). The scenarios comprised first-line treatment with haloperidol depot (scenario 1), long-acting risperidone (scenario 2) and oral olanzapine (scenario 3). Switches to second or third-line options were allowed when side-effects occurred or a patient suffered more than a fixed number of relapses. The model accounted for fixed patient characteristics, and on the basis of these, simulated patient histories according to several time-dependent variables. The time horizon for this model was limited to 5 years, and in accordance with German guidelines, costs and effects were discounted by between 3 and 10%. Direct costs included medication, type of physician visits and treatment location. Indirect costs were not included. Information on treatment alternatives, transition probabilities, model structure and healthcare utilization were derived from the literature and an expert panel. Outcomes were expressed in terms of the number and duration of psychotic episodes, cumulative symptom scores, costs, and quality-adjusted life-years (QALY). Univariate sensitivity analyses were carried out, as were subgroup analyses based on disease severity and for patients at high risk of being non-compliant. The long-acting risperidone strategy was calculated to avoid 0.23 and 0.33 relapses per patient, decrease the cumulative symptom score by 25 and 33 points, and decrease the costs by 2017 Euro and 6096 Euro per patient (1608 Euro and 5422 Euro discounted), compared with the haloperidol depot and olanzapine strategies, respectively, over a 5-year period (year of costing 2004). Among high-risk non-compliant patients, long-acting risperidone was estimated to avoid 0.23 and 0.47 relapses and save 4822 Euro and 10,646 Euro per patient (4107 Euro and 9490 Euro discounted), compared with the haloperidol depot and olanzapine strategies, respectively. Sensitivity analyses showed that the results were robust and mainly sensitive to changes in the reported relative effectiveness of atypical and conventional formulations for preventing symptom recurrence, and in the relative compliance with oral and long-acting formulations. In this model, long-acting risperidone is a dominant strategy compared with a haloperidol depot...

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

“…Similarly, the mean cost-effectiveness ratios were • 19 839, • 22 826, and • 38 008 per successfully treated patient for long-acting risperidone, olanzapine, and haloperidol, respectively. Cost savings were also observed when long-acting risperidone was compared with oral olanzapine and long-acting haloperidol in a German study (Laux et al 2005). In this study a discrete-event simulation model was developed to compare the benefits and costs of three pharmacological treatment strategies from the perspective of major third party payers (sickness funds and social security) over a 5-year period in Germany.…”

“…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). …”

“…Outcomes were expressed in terms of the number and duration of psychotic episodes, cumulative symptom scores, costs, and quality-adjusted-life-years (QALY). The long-acting risperidone strategy was calculated to avoid 0.23 and 0.33 relapses per patient, decrease the cumulative symptom score by 25 and 33 points, and decrease costs by • 2017 and • 6096 per patient (• 1608 and • 5422 discounted), compared with the long-acting haloperidol and olanzapine strategies respectively, over 5 years (Laux et al 2005). …”

Cost Effectiveness of Long-Acting Risperidone in Sweden

“…The limitations of the model have been described in detail elsewhere; [7][8][9][10] however, there are some specific observations regarding this investigation. The clinical trials of RLAI conducted in 2005 did not provide sufficient information on which to judge the full clinical and economic benefits of RLAI in Sweden.…”

“…An existing DES model, previously used for economic analyses of RLAI and other antipsychotics in several countries, [7][8][9][10] was adapted to reflect the treatment of schizophrenia in Sweden. The perspective adopted in this model was that of the Swedish healthcare system.…”