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Pharmacoeconomic analysis of paliperidone palmitate versus olanzapine pamoate for chronic schizophrenia in Norway

  • Thomas R. Einarson (a1), Colin Vicente (a2), Roman Zilbershtein (a2), Charles Piwko (a2), Christel N. Bø (a3), Hanna Pudas (a4) and Michiel E. H. Hemels (a5)...

Abstract

Objective

Paliperidone palmitate long‐acting injection (PP‐LAI) has recently been approved for treatment of chronic schizophrenia. Its cost‐effectiveness has not been established. The objective was to compare direct costs and outcomes between PP‐LAI and olanzapine pamoate (OLZ‐LAI) in treating chronic schizophrenia in Norway from the perspective of the government payer.

Methods

We used a decision analytic model over a 1‐year time horizon. Clinical inputs were derived from the literature and an expert panel; costs were taken from standard lists, adjusted to 2010 Norwegian kroner (NOK). Discounting was not done. Main outcomes included average cost per patient treated, hospitalisations, emergency room (ER) visits and quality‐adjusted life years (QALYs). The pharmacoeconomic outcome was the incremental cost per QALY. Robustness was examined using one‐way sensitivity analyses on critical variables and a 5000‐iteration probabilistic Monte Carlo sensitivity analysis with all variables included.

Results

PP‐LAI generated 0.845 QALY at a cost of 151 336 NOK of which 23% was due to drugs; 25% of patients were hospitalised and another 12% required ER visits. OLZ‐LAI cost 174 351 NOK (21% due to drugs); patient outcomes included 0.844 QALY, 27% hospitalisations and 14% ER visits. PP‐LAI dominated OLZ‐LAI in the base case. The analysis was reasonably robust against variations in drug cost but sensitive to small changes in adherence and hospitalisation rates. Overall, PP‐LAI was dominant over OLZ‐LAI in 54.5% of simulations. Replacing OLZ‐LAI with PP‐LAI would be cost saving for the Norwegian healthcare system.

Conclusion

PP‐LAI was cost‐effective compared with OLZ‐LAI in treating patients with chronic schizophrenia in Norway but sensitive to changes in adherence and hospitalisation rates.

Copyright

Corresponding author

Thomas R. Einarson, PhD, Leslie Dan Faculty of Pharmacy, Toronto, ON M5V 3 M8 Canada. Tel: +416‐978‐6212; Fax: +416‐978‐1833; E‐mail: t.einarson@rogers.com

References

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1Karagianis, J, Novick, D, Pecanek, J et al. Worldwide‐Schizophrenia Outpatient Health Outcomes (W‐SOHO): baseline characteristics of pan‐regional observational data from more than 17,000 patients. Int J Clin Pract 2009;63:15781588.
2Möller, H‐J. Long‐acting injectable risperidone for the treatment of schizophrenia: clinical perspectives. Drugs 2007;67:15411566.
3Kane, J, Eerdekens, M, Lindenmayer, J‐P, Keith, S, Lesem, M, Karcher, K. Long‐acting injectable risperidone: efficacy and safety of the first long‐acting atypical antipsychotic. Am J Psychiatry 2003;160:11251132.
4Nasrallah, H. The case for long‐acting antipsychotic agents in the post‐CATIE era. Acta Psychiatr Scand 2007;115:260267.
5Nielsen, J, Le Quach, P, Emborg, C et al. 10‐Year trends in the treatment and outcomes of patients with first‐episode schizophrenia. Acta Psychiatr Scand 2010;122:356366.
6European Medicines Agency. Risperdal Consta® summary of product characteristics. URL http://www.ema.europa.eu/docs/en_GB/document_library/Referrals_document/Risperdal_Consta_30/WC500008170.pdf [accessed on 8 August 2011].
7European Medicines Agency. Assessment report for Zypadhera. Doc. Ref EMEA/608654/2008. URL http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Public_assessment_report/human/000890/WC500054428.pd. Procedure No. EMEA/H/C/000890, 163. 2008 [accessed on 8 August 2011].
9Detke, H, Mcdonnell, D, Brunner, E et al. Post‐injection delirium/sedation syndrome in patients with schizophrenia treated with olanzapine long‐acting injection, I: analysis of cases. BMC Psychiatry 2010;10:32.
10Alphs, L, Gopal, S, Karcher, K et al. Are long‐acting intramuscular formulations of risperidone or paliperidone palmitate associated with post‐injection delirium sedation syndrome? An assessment of safety databases. Curr Drug Saf 2011;6:4345.
11Furiak, N, Ascher‐Svanum, H, Klein, R et al. Cost‐effectiveness of olanzapine long‐acting injection in the treatment of patients with schizophrenia in the United States: a micro‐simulation economic decision model. Curr Med Res Opin 2011;27:713740.
12Glazer, W, Ereshefsky, L. A pharmacoeconomic model of outpatient antipsychotic therapy in "revolving door" schizophrenic patients. J Clin Psychiatry 1996;57:337345.
13European Medicines Agency. Xeplion® summary of product characteristics. URL http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/000890/WC500054429.pdf [accessed on 8 August 2011].
14European Medicines Agency. Zypadhera® summary of product characteristics. URL http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_Product_Information/human/000890/WC500054429.pdf. 20‐4‐2010 [accessed on 8 August 2011].
15Gopal, S, Vijapurkar, U, Lim, P, Morozova, M, Eerdekens, M, Hough, D. A 52‐week open‐label study of the safety and tolerability of paliperidone palmitate in patients with schizophrenia. J Psychopharmacol 2010;25:685697.
16Fleischhacker, WW, Gopal, S, Lane, L et al. A randomized trial of paliperidone palmitate and risperidone long‐acting injectable in schizophrenia. Int J Neuropsychopharmacol 2011;22:112. DOI: 10.1017/S1461145711001076.
17Kane, J, Detke, H, Naber, D et al. Olanzapine long‐acting injection: a 24‐week, randomized, double‐blind trial of maintenance treatment in patients with schizophrenia. Am J Psychiatry 2010;167:181189.
18Gopal, S, Hough, D, Xu, H et al. Efficacy and safety of paliperidone palmitate in adult patients with acutely symptomatic schizophrenia: a randomized, double‐blind, placebo‐controlled, dose–response study. Int Clin Psychopharmacol 2010;25:247256.
19Pandina, GJ, Lane, R, Gopal, S et al. A double‐blind study of paliperidone palmitate and risperidone long‐acting injectable in adults with schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2011;35:218226.
20Hough, D, Lindenmayer, J‐P, Gopal, S et al. Safety and tolerability of deltoid and gluteal injections of paliperidone palmitate in schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2009;33:10221031.
21Nasrallah, HA, Gopal, S, Gassmann‐Mayer, C et al. A controlled, evidence‐based trial of paliperidone palmitate, a long‐acting injectable antipsychotic, in schizophrenia. Neuropsychopharmacology 2010;35:20722082.
22Pandina, GJ, Lindenmayer, J‐P, Lull, JM et al. A randomized, placebo‐controlled study to assess the efficacy and safety of 3 doses of paliperidone palmitate in adults with acutely exacerbated schizophrenia. J Clin Psychiatry 2010;30:235244.
23Lauriello, J, Lambert, T, Andersen, S, Lin, D, Taylor, C, Mcdonnell, D. An 8‐week, double‐blind, randomized, placebo controlled study of olanzapine long‐acting injection in acutely ill patients with schizophrenia. J Clin Psychiatry 2008;69:790799.
24Hough, D, Gopal, S, Vijapurkar, U, Lim, P, Morozova, M, Eerdekens, M. Paliperidone palmitate maintenance treatment in delaying the time‐to‐relapse in patients with schizophrenia: a randomized, double‐blind, placebo‐controlled study. Schiz Res 2010;116:107117.
25Morken, G, Widen, J, Grawe, R. Non‐adherence to antipsychotic medication, relapse and rehospitalisation in recent‐onset schizophrenia. BMC Psychiatry 2008;8:18.
26Simonsen, E, Friis, S, Opjordsmoen, S et al. Early identification of non‐remission in first‐episode psychosis in a two‐year outcome study. Acta Psychiatr Scand 2010;122:375383.
27Kane, J, Honigfeld, G, Singer, J et al. Clozapine for the treatment‐resistant schizophrenic: a double‐blind comparison with chlorpromazine. Arch Gen Psychiatry 1988;45:789796.
28Leponex product monograph. Oslo: Novartis Norge AS, 5 May 2010.
29Wahlbeck, K, Cheine, M, Essali, A, Adams, C. Evidence of clozapine's effectiveness in schizophrenia: a systematic review and meta‐analysis of randomized trials. Am J Psychiatry 1999;156:990999.
30Olivares, J, Peuskens, J, Pecanek, J et al. Clinical and resource‐use outcomes of risperidone long‐acting injection in recent and long‐term diagnosed schizophrenia patients: results from a multinational electronic registry. Curr Med Res Opin 2009;25:21972206.
31Mehnert, A, Diels, J. Impact of administration interval on treatment retention with long‐acting antipsychotics in schizophrenia. Presented at the Tenth Workshop on Costs and Assessment in Psychiatry – Mental Health Policy and Economics; 25–27 March 2011, Venice, Italy. 2011.
32Ascher‐Svanum, H, Faries, D, Zhu, B et al. Medication adherence and long‐term functional outcomes in the treatment of schizophrenia in usual care. J Clin Psychiatry 2006;67:453460.
33Weiden, P, Kozma, C, Grogg, A et al. Partial compliance and risk of rehospitalization among California Medicaid patients with schizophrenia. Psychiatr Serv 2004;55:886891.
34Nicholl, D, Akhras, K, Diels, J et al. Burden of schizophrenia in recently diagnosed patients: healthcare utilisation and cost perspective. Curr Med Res Opin 2010;26:943955.
35Norwegian Medicines Agency. Database – approved and marketed pharmaceuticals. URL http://www.legemiddelverket.no/custom/Preparatsok/prepSearch_80333.aspx [accessed on 26 November 2011].
36Norwegian Health Directorate. Samdata specialisthelsetjenesten 2009. URL http://www.helsedirektoratet.no/vp/multimedia/archive/00300/Samdata_spesialisth_300999a.pdf. Norwegian Health Directorate [accessed on 6 June 2011].
37European Central Bank. Statistical data warehouse. URL http://sdw.ecb.europa.eu/quickview.do?SERIES_KEY=120.EXR.A.NOK.EUR.SP00.A [accessed on 6 June 2011].
39Berg, J, Restan, A. Duration of bed occupancy as calculated at a random chosen day in an acute care ward. Implications for the use of scarce resources in psychiatric care. Arch Gen Psychiatry 2005;4:16.
40McCracken, C, Dalgard, O, Ayuso‐Mateos, J et al. Health service use by adults with depression: community survey in five European countries Evidence from the ODIN study. Br J Psychiatry 2006;181:161167.
41Svendsen, B, Myhr, K, Nyland, H et al. The cost of multiple sclerosis in Norway – (and how certain can we be?). Bergen: Institutt for foretaksøkonomi, Department of Finance and Management Science, 2006.
42Briggs, A, Wild, D, Lees, M et al. Impact of schizophrenia and schizophrenia treatment‐related adverse events on quality of life: direct utility elicitation. Health Qual Life Outcomes 2008;6:105.
43Cummins, C, Stevens, A, Kisely, S. The use of olanzapine as a first and second choice treatment in schizophrenia. Birmigham, UK: Department of Public Health & Epidemiology, University of Birmingham. A West Midlands Development and Evaluation Committee Report, 1998.
44Lenert, L, Sturley, A, Rapaport, M et al. Public preferences for health states with schizophrenia and a mapping function to estimate utilities from positive and negative symptom scale scores. Schiz Res 2004;71:155165.
45Oh, P, Lanctôt, K, Mittmann, N et al. Cost‐utility of risperidone compared with standard conventional antipsychotics in chronic schizophrenia. J Med Econ 2001;4:137156.
46Revicki, D, Shakespeare, A, Kind, P. Preferences for schizophrenia‐related health states: a comparison of patients, caregivers and psychiatrists. Int Clin Psychopharmacol 1996;11:101108.
47Statistics Norway. URL http://www.ssb.no/en/ [accessed on 5 December 2011].
48Faerden, AA, Waal, HH, Rønnow, SS. Long‐term psychiatric patients in a sector of Oslo. Tidsskr Nor Laegeforen 1995;115:36383641.
49National Institute for Health and Clinical Excellence (NICE). URL http://www.nice.org.uk/ [accessed on 5 December 2011].
50Yahoo Finance currency converter. http://ca.finance.yahoo.com/currencies/converter/#from=GBP;to=EUR;amt=1 [accessed on 4 December 2011].
51Pandina, GJ, Lane, R, Gopal, S et al. A randomized, double‐blind, comparative study of flexible doses of paliperidone palmitate and risperidone long‐acting therapy in patients with schizophrenia. Presented at the American College of Neuropsychopharmacology 48th Annual Meeting, Hollywood, FL, 6–10 December 2009.
52Einarson, T, Hemels, M, Nuamah, I et al. Hyperprolactinemia with paliperidone palmitate: analysis of adverse events and abnormal laboratory values in randomized clinical trials. Ann Pharmacother 2012;46 (In submission).
53All Wales Medicines Strategy Group. Final appraisal report: Olanzapine depot (ZypAdhera®), Lilly UK. Advice No: 1510 – October 2010. URL http://www.wales.nhs.uk/sites3/Documents/371/olanzapine%20depot%20(ZypAdhera)%20schizophrenia.pdf [accessed on 8 August 2011].
54Farahati, F, Boucher, M, Moulton, K et al. Atypical antipsychotic monotherapy for schizophrenia: clinical review and economic evaluation of first year of treatment [Technology report number 91]. Ottawa: Canadian Agency for Drugs and Technologies in Heath, 2007.
55Tenback, DE, van Harten, PN, Slooff, CJ, van Os, J. Incidence and persistence of tardive dyskinesia and extrapyramidal symptoms in schizophrenia. J Psychopharmacol 2010;24:10311035.
56Honkonen, T, Henriksson, M, Koivisto, AM, Stengård, E, Salokangas, RK. Violent victimization in schizophrenia. Soc Psychiatry Psychiatr Epidemiol 2004;39:606612.
57Laajasalo, T, Hakkanen, H. Excessive violence and psychotic symptomatology among homicide offenders with schizophrenia. Crim Behav Ment Health 2006;16:242253.
58Boye, B, Bentsen, H, Ulstein, I et al. Relatives' distress and patients' symptoms and behaviours: a prospective study of patients with schizophrenia and their relatives. Acta Psychiatr Scand 2001;104:4250.

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