PMH26 Cost-Effectiveness of Atypical Versus Typical Antipsychotics in Patients With Schizophrenia in Russia

Abstract

To estimate cost-effectiveness of different (7 drugs) peroral atypical antipsychotics (AAP) vs haloperidol (H) for the treatment of schizophrenia. Cost-effectiveness analysis of AAP compared to H for schizophrenia treatment was performed. A mathematical model based on simulation of treatment outcomes in hypothetical cohort of patients was developed. Key parameters of the model were determined using systematic review of the RCTs results (improvement in clinical and functional status as measured by the PANSS and CGI, frequency of relapse, adverse events), e-STAR observational study (local data for Russia), epidemiological data and expert panel opinions. For each option direct costs of treatment were considered: hospitalization and outpatient care, and the cost of medications for AAP- and H-based treatment. ICER (cost of a day without exacerbation of the disease) for each AAP was calculated vs H. According to published trials the treatment of schizophrenia in the AAP-based therapy was associated with a significant improvement in PANSS and CGI, decreased rate of relapse and adverse events compared to H-based treatment. Analysis of the results of RCTs has not shown superiority of any certain drug inside the AAP group. In case of application of AAP-based therapy hospitalization rate decreases by 38% compared to H-based treatment but the total cost of treatment remains lower for H. Depending on the drug ICERaap for AAP vs H varies from 4,202 USD to 18,157 USD per day without exacerbation of the disease. In group AAP paliperidone has the lowest ICER vs H - 4202 USD. Results of the study suggest that AAP-are more efficacious compared to H, the total cost of treatment remains lower for H. In-group AAP paliperidone is more cost-effective.