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Cost effectiveness of paliperidone palmitate versus risperidone long-acting injectable and olanzapine pamoate for the treatment of patients with schizophrenia in Sweden

Mehnert, Angelika, Nicholl, Deborah, Pudas, Hanna, Martin, Monique and McGuire, Alistair (2012) Cost effectiveness of paliperidone palmitate versus risperidone long-acting injectable and olanzapine pamoate for the treatment of patients with schizophrenia in Sweden. Journal of Medical Economics, 15 (5). pp. 844-861. ISSN 1369-6998

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Abstract

Objective: To model the cost effectiveness of paliperidone palmitate (paliperidone long-Acting injectable; PLAI), a new once-monthly long-Acting antipsychotic therapy, compared with risperidone long-Acting injectable (RLAI) and olanzapine pamoate (OLAI), in multi-episode patients (two or more relapses) with schizophrenia in Sweden. Methods: A Markov decision analytic model was developed to simulate the history of a cohort of multi-episode patients transitioning through different health states on a monthly basis over a 5-year time horizon from the perspective of the Swedish healthcare system. Therapeutic strategies consisted of starting treatment with RLAI (mean dose 37.5mg every 2 weeks), PLAI (mean dose 75mg equivalent (eq.) every month) or OLAI (150mg every 2 weeks or 300mg every 4 weeks). Probability of relapse, level of adherence, side-effects (extrapyramidal symptoms, tardive dyskinesia, weight gain and diabetes) and treatment discontinuation (switch) were derived from long-term observational data when feasible. Incremental cost-effectiveness outcomes, discounted at 3% annually, included cost per quality-Adjusted life-year (QALY) and cost per relapse avoided (expressed in 2009 Swedish Krona SEK). Results: Relative to RLAI and OLAI, PLAI is economically dominant: more effective (additional QALYs, less relapses) and less costly treatment option over a 5-year time horizon. The results were robust when tested in sensitivity analysis. Limitations: The impact of once-monthly treatment on adherence levels is not yet known, and not all variables that could impact on real-world outcomes and costs were included in this model. Conclusion: PLAI was cost saving from a Swedish payer perspective compared with RLAI and OLAI in the long-term treatment of multi-episode (two or more relapses) schizophrenia patients.

Item Type: Article
Official URL: http://www.jmejournal.com/
Additional Information: © 2012 Informa UK
Library of Congress subject classification: H Social Sciences > HC Economic History and Conditions
R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
Journal of Economic Literature Classification System: I - Health, Education, and Welfare > I1 - Health
Sets: Departments > Social Policy
Collections > Economists Online
Research centres and groups > LSE Health
Rights: http://www.lse.ac.uk/library/usingTheLibrary/academicSupport/OA/depositYourResearch.aspx
Date Deposited: 11 Sep 2012 08:44
URL: http://eprints.lse.ac.uk/45764/

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