POSA46 Cost Analysis of Lurasidone for the Treatment of Schizophrenia in Adults within the United Kingdom

Abstract

An economic model was built to establish the incremental costs of lurasidone, a second-generation atypical antipsychotic, when introduced as a first-line adult schizophrenia treatment in the UK. The incremental cost of the following treatment sequences was estimated: lurasidone, cariprazine, brexpiprazole, clozapine versus cariprazine, brexpiprazole, lurasidone and clozapine. The costs of either lurasidone or cariprazine were compared as first-line options because there are currently no restrictions on treatment lines of schizophrenia therapy. A Markov model incorporating the following health states was developed: stable (receiving, or temporarily discontinued from, treatment) and relapse. Patient movement between health states was dependent on six-weekly probabilities of relapse and discontinuation due to intolerable side effects or any other reasons. All efficacy data were obtained from network meta-analyses. A six-week cycle length was used and a 3.5% discount rate was applied to costs over a five-year time horizon. Resource use and unit costs were reflective of the NHS and were obtained from published literature. Costs included treatment, outpatient, adverse events, primary and residential care. An increased mortality risk associated with schizophrenia was applied to all patients. Deterministic sensitivity analysis was undertaken to assess the uncertainty of the economic Results: The treatment sequence containing lurasidone as a first-line treatment resulted in a cost-saving of £816 per patient. First-line lurasidone was associated with increased treatment, stable health state and adverse event costs (£570, £107 and £6 per patient respectively). However, these costs were outweighed by the cost-savings within the relapse health state (savings of £1,499 per patient). Deterministic sensitivity analysis demonstrated the results were most sensitive to discontinuation rates, relapse rates and relapse residential costs. However, no variation in inputs caused first-line lurasidone to become cost-incurring. Lurasidone is a cost-saving intervention for the treatment of schizophrenia in adults when received first-line in a UK setting.