PMH13 ESTIMATING THE BENEFIT OF LONG-ACTING INJECTABLES FOR SCHIZOPHRENIA TREATMENT IN RWANDA USING A ONE-YEAR COST-CONSEQUENCE MODEL

Abstract

A one-year cost-consequence model was developed to estimate health and economic impact of paliperidone palmitate long-acting formulations, 1-monthly (PP1M) and 3-monthly (PP3M), compared to current standard of care for the treatment of schizophrenia in Rwanda The model measures key goals and outcomes of schizophrenia treatment including hospitalization, relapse, and treatment persistence as well as key adverse events with direct and indirect costs specific to Rwanda. Clinical inputs were based on mixed treatment comparisons of pivotal phase III clinical trials while cost inputs were based on local standard of care data collected by a blinded randomized audit of schizophrenia patients conducted at Ndera Neuropsychiatric Hospital in Kigali. Supplemental data was collected from the annual report and other documents on hospital tariffs, travel costs to the hospital, cost of medicines on formulary, and distribution of patients by insurance category. The great majority of patients received first-generation antipsychotics, mainly in oral form. Risperidone and Olanzapine were the only available second-generation antipsychotics. Patients from across Rwanda are required to visit a health facility (usually Ndera Neuropsychiatric Hospital in the capital, Kigali) once a month to refill their prescriptions. The average patient has 1.2 hospitalisations per year. Travel costs, in addition to traditional direct medical costs, make up a significant proportion of patient costs associated with schizophrenia treatment. Using the model to compare PP3M to haloperidol, the predominant standard of care, over the course of one year, patients on long-acting injectables spent more months on treatment (10.7 vs 9.8 months), had fewer relapses (0.20 vs 0.43 relapses) and needed fewer days in hospital (8 vs 16 days). Schizophrenia imposes significant health and economic burden on schizophrenia patients and caregivers. The improved outcomes suggest there may be a role for second generation LAIs for the treatment of schizophrenia patients in Rwanda.