Cost-Utility Analysis of Depot Atypical Antipsychotics for Chronic Schizophrenia in Croatia

Vlado Jukic; Miro Jakovljevic; Igor Filipcic; Miroslav Herceg; Ante Silic; Tatjana Tomljanovic; Roman Zilbershtein; Rasmus C D Jensen; Michiel E H Hemels; Thomas R Einarson

doi:10.1016/j.vhri.2013.06.008

Cost-Utility Analysis of Depot Atypical Antipsychotics for Chronic Schizophrenia in Croatia

Value Health Reg Issues. 2013 Sep-Oct;2(2):181-188. doi: 10.1016/j.vhri.2013.06.008. Epub 2013 Sep 13.

Authors

Affiliations

¹ University Psychiatric Hospital "Vrapce," Zagreb, Croatia.
² Department of Psychiatry, University Hospital of Zagreb, Zagreb, Croatia.
³ University Psychiatric Hospital "Sv Ivan," Zagreb, Croatia.
⁴ Janssen Division of Johnson & Johnson S.E., Zagreb, Croatia.
⁵ Pivina Consulting, Inc., Mississauga, Canada.
⁶ Janssen Cilag, Birkerød, Denmark.
⁷ Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada. Electronic address: t.einarson@rogers.com.

PMID: 29702863
DOI: 10.1016/j.vhri.2013.06.008

Abstract

Objectives: As a nation with a developing economy, Croatia is faced with making choices between pharmaceutical products, including depot injectable antipsychotics. We conducted a pharmacoeconomic analysis to determine the cost-effectiveness of atypical depots in Croatia.

Methods: A 1-year decision-analytic framework modeled drug use. We determined the average direct cost to the Croatian Institute for Health Insurance of using depot formulations of paliperidone palmitate long-acting injectable (PP-LAI), risperidone LAI (RIS-LAI), or olanzapine LAI (OLZ-LAI). An expert panel plus literature-derived clinical rates populated the core model, along with costs adjusted to 2012 by using the Croatian consumer price index. Clinical outcomes included quality-adjusted life-years, hospitalization rates, emergency room treatment rates, and relapse days. Robustness of results was examined with one-way sensitivity analyses on important inputs; overall, all inputs were varied over 10,000 simulations in a Monte Carlo analysis.

Results: Costs (quality-adjusted life-years) per patient were €5061 (0.817) for PP-LAI, €5168 (0.807) for RIS-LAI, and €6410 (0.812) for OLZ-LAI. PP-LAI had the fewest relapse days, emergency room visits, and hospitalizations. Results were sensitive against RIS-LAI with respect to drug costs and adherence rates, but were generally robust overall, dominating OLZ-LAI in 77.3% and RIS-LAI in 56.8% of the simulations.

Conclusions: PP-LAI dominated the other drugs because it had the lowest cost and best clinical outcomes. Compared with depots of olanzapine and risperidone and oral olanzapine, PP-LAI was the cost-effective atypical LAI for treating chronic schizophrenia in Croatia. Using depot paliperidone in place of either olanzapine or risperidone would reduce the overall costs of caring for these patients.

Keywords: Croatia; long-acting injectable; paliperidone palmitate; pharmacoeconomic analysis; risperidone; schizophrenia.