Abstract
Asenapine is a new atypical antipsychotic approved in Turkey for the treatment of schizophrenia and bipolar I disorder. Asenapine has demonstrated comparable efficacy over olanzapine in controlling both positive and negative symptoms of schizophrenia in the long-term. However, unlike olanzapine, asenapine is associated with a favorable metabolic profile as well as with a minimal weight gain. Post-hoc analyses of a clinical study vs. olanzapine illustrated higher incidence of developing metabolic syndrome (MetS) with olanzapine than with asenapine after 52 weeks of treatment. The aim of this study is to assess the cost-effectiveness of asenapine in schizophrenia compared with the most widely used atypical antipsychotics in Turkey with a focus on the long-term consequences of MetS which increases the risk of diabetes and cardiovascular diseases (CVD). Perspective of National Pharmaceutical Reimbursement Authority was applied and life expectancy horizon was adopted. Annual risks of metabolic syndrome were derived from randomized clinical studies of asenapine and indirect comparison of other atypical antipsychotics vs. olanzapine. Risks of developing diabetes and CVD were based on published risk models. Treatment costs associated with metabolic consequences as well as cost of atypical antipsychotics were derived from local sources. Number of diabetes and CVD avoided is used as effectiveness measure in the model. Asenapine dominates (more effective and less expensive) all atypical antipsychotics in the treatment of schizophrenia. Compared to olanzapine, quetiapine, aripiprazole, risperidone and paliperidone (all genericized except paliperidone), asenapine was associated with incremental total costs of 1908 TL, 1298 TL, 314 TL, 841 TL and 1958 TL; and associated with incremental total number of diabetes & CVD avoided of 0.046, 0.029, 0.001, 0.028 and 0.028 respectively. The lower incidence of developing MetS associated with asenapine compared to olanzapine and other atypicals is associated with lower treatment costs and lower incidence of diabetes and CVD in Turkey.
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