Korean J Psychopharmacol.  2012 Jan;23(1):17-27.

Cost-Utility Analysis of Paliperidone Palmitate Long Acting Injection (PLAI) versus Oral Atypical Antipsychotics in Non-Adherent Schizophrenia Patients in South Korea

• Kim BR
• Lee TJ
• Woo JM
• Park JI
• Kwon JS

Abstract

OBJECTIVE
Schizophrenia is a chronic and persistent mental illness and requires continuous treatment. Nevertheless, a majority of schizophrenia subjects show non-adherence to oral antipsychotics due to many factors including a lack of insight and a decline in their cognitive function. Medication non-adherence is associated with an increase in relapse and hospitalization and incurs a heavy burden not only to subjects and caregivers, but also to society. Treatment with antipsychotic long acting injection can maintain a consistent plasma drug concentration and has been shown to prevent relapse and re-hospitalization. This study aims to assess the cost-effectiveness of paliperidone palmitate long acting injection (PLAI) compared with atypical oral antipsychotics (risperidone, olanzapine, aripiprazole and paliperidone) in schizophrenia subjects who are non-adherent to oral atypical antipsychotics.
METHODS
A decision-tree model was constructed to compare the clinical and economic outcomes of PLAI and oral comparator over 1 year in schizophrenia subjects who are non-adherent to oral atypical antipsychotics. Clinical data such as relapse rate, extra pyramidal symptoms (EPS) rate, suicide rate and non-adherence rate were obtained from published literature. Utility values for each schizophrenia health state were calculated based on an Australian study to measure the utility values for schizophrenia patients. Direct medical cost data were obtained from domestic literature. Sensitivity analyses were performed on major variables.
RESULTS
Based on model estimates, PLAI can increase quality-adjusted life years (QALY) per patient by 0.39 and is associated with a 2.93-fold lower probability of relapse compared with the weighted average of the oral treatments (0.2204 vs 0.6462). The total annual medical costs per patient (including medication, inpatient and outpatient cost) were 4.51 million Korean Won for PLAI, and 5.19 million Korean Won for the weighted average of oral atypical antipsychotics, leading to a cost reduction of 0.68 million Korean Won with PLAI.
CONCLUSION
With lower total medical cost and improved treatment outcomes compared to oral treatments, PLAI was assessed to be a dominant treatment option for schizophrenia patients who are non-adherent to oral atypical antipsychotics.

Keyword

Schizophrenia; Long-acting; Antipsychotics; Paliperidone palmitate; Cost-utility analysis

MeSH Terms

Antipsychotic Agents
Benzodiazepines
Caregivers
Hospitalization
Humans
Inpatients
Isoxazoles
Medication Adherence
Outpatients
Palmitates
Piperazines
Plasma
Pyrimidines
Quality-Adjusted Life Years
Quinolones
Recurrence
Republic of Korea
Schizophrenia
Suicide
Aripiprazole
Paliperidone Palmitate
Antipsychotic Agents
Benzodiazepines
Isoxazoles
Palmitates
Piperazines
Pyrimidines
Quinolones