PMID- 24758296
OWN - NLM
STAT- MEDLINE
DCOM- 20150331
LR  - 20220321
IS  - 1941-837X (Electronic)
IS  - 1369-6998 (Linking)
VI  - 17
IP  - 8
DP  - 2014 Aug
TI  - Cost-effectiveness of aripiprazole once-monthly compared with paliperidone 
      palmitate once-monthly injectable for the treatment of schizophrenia in the 
      United States.
PG  - 567-76
LID - 10.3111/13696998.2014.917089 [doi]
AB  - OBJECTIVE: To develop a decision-analytic model to estimate the 
      cost-effectiveness of initiating maintenance treatment with aripiprazole 
      once-monthly (AOM) vs paliperidone long-acting injectable (PLAI) once-monthly 
      among patients with schizophrenia in the US. METHODS: A decision-analytic model 
      was developed to evaluate a hypothetical cohort of patients initiating 
      maintenance treatment with AOM or PLAI. Rates of relapse, adverse events (AEs), 
      and direct medical costs were estimated for 1 year. Patients either remained on 
      initial treatment or discontinued treatment due to lack of efficacy, AEs, or 
      other reasons, including non-adherence. Data from placebo-controlled pivotal 
      trials and product prescribing information (PI) were used to estimate treatment 
      efficacy and AEs. Analyses were performed assuming dosing of clinical trials, 
      real-world practice, PIs, and highest therapeutic dose available, because of 
      variation in practice settings. The main outcome of interest was incremental cost 
      per schizophrenia hospitalization averted with AOM vs PLAI. RESULTS: Based on 
      placebo-controlled pivotal trials' dosing, AOM improved clinical outcomes by 
      reducing schizophrenia relapses vs PLAI (0.181 vs 0.277 per person per year 
      [pppy]) at an additional cost of US$1276 pppy, resulting in an incremental 
      cost-effectiveness ratio (ICER) of US$13,280/relapse averted. When PI dosing was 
      assumed, this ICER increased to US$19,968/relapse averted. When real-world dosing 
      and highest available dosing were assumed, AOM was associated with fewer relapses 
      and lower overall treatment costs vs PLAI. CONCLUSIONS: AOM consistently provided 
      favorable clinical benefits. Under various dosing scenarios, AOM results 
      indicated fewer relapses at lower overall costs or a reasonable 
      cost-effectiveness threshold (i.e., less than the cost of a hospitalization 
      relapse) vs PLAI. Given the heterogeneous nature of schizophrenia and variability 
      in treatment response, health plans may consider open access for treatments like 
      AOM. Since model inputs were based on data from separate placebo-controlled 
      trials, generalization of results to the real-world setting is limited.
FAU - Citrome, Leslie
AU  - Citrome L
AD  - Department of Psychiatry & Behavioral Sciences, New York Medical College , 
      Valhalla, NY , USA.
FAU - Kamat, Siddhesh A
AU  - Kamat SA
FAU - Sapin, Christophe
AU  - Sapin C
FAU - Baker, Ross A
AU  - Baker RA
FAU - Eramo, Anna
AU  - Eramo A
FAU - Ortendahl, Jesse
AU  - Ortendahl J
FAU - Gutierrez, Benjamin
AU  - Gutierrez B
FAU - Hansen, Karina
AU  - Hansen K
FAU - Bentley, Tanya G K
AU  - Bentley TG
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20140512
PL  - England
TA  - J Med Econ
JT  - Journal of medical economics
JID - 9892255
RN  - 0 (Antipsychotic Agents)
RN  - 0 (Isoxazoles)
RN  - 0 (Palmitates)
RN  - 0 (Piperazines)
RN  - 0 (Quinolones)
RN  - 82VFR53I78 (Aripiprazole)
RN  - R8P8USM8FR (Paliperidone Palmitate)
SB  - IM
MH  - Antipsychotic Agents/*administration & dosage/adverse effects/*economics
MH  - Aripiprazole
MH  - *Cost-Benefit Analysis
MH  - Decision Support Techniques
MH  - Drug Administration Schedule
MH  - Humans
MH  - Injections, Intramuscular
MH  - Isoxazoles/administration & dosage/*economics
MH  - Paliperidone Palmitate
MH  - Palmitates/administration & dosage/*economics
MH  - Piperazines/administration & dosage/*economics
MH  - Quinolones/administration & dosage/*economics
MH  - Schizophrenia/*drug therapy/economics
MH  - United States
OTO - NOTNLM
OT  - Aripiprazole once-monthly
OT  - Cost-effectiveness
OT  - Long-acting injectable
OT  - Paliperidone palmitate
EDAT- 2014/04/25 06:00
MHDA- 2015/04/01 06:00
CRDT- 2014/04/25 06:00
PHST- 2014/04/25 06:00 [entrez]
PHST- 2014/04/25 06:00 [pubmed]
PHST- 2015/04/01 06:00 [medline]
AID - 10.3111/13696998.2014.917089 [doi]
PST - ppublish
SO  - J Med Econ. 2014 Aug;17(8):567-76. doi: 10.3111/13696998.2014.917089. Epub 2014 
      May 12.