Antipsychotic Costs Research Articles

A cross-sectional observational drug utilisation study of antipsychotic drugs prescribed in patients suffering from psychiatric illnesses at a tertiary care hospital

Background: The rapidly expanding field of psychopharmacotherapy is challenging the traditional concepts of psychiatric treatment and research and is constantly seeking new and improved drugs to treat psychiatric disorders.Methods: The present study was undertaken to analyse the pattern of drug utilization of antipsychotic medications in outdoor patients of psychiatry department of a tertiary care hospital. 600 prescriptions of 600 patients suffering from different psychiatric illnesses were taken for analyses in which antipsychotic agents were prescribed either as a main drug or as a concomitant agent after proper taking written informed consent.Results: A total of 1681 drugs were prescribed in our study population The average number of drugs prescribed per prescription in the study population was 2.61±1.32. Schizophrenia, bipolar disorder, depression were among the most common illnesses for which antipsychotics were prescribed. Atypical antipsychotics were most commonly prescribed in the study population out of which olanzapine was prescribed in most of the patients. Considering the cost analysis of the present study, the average cost per prescription was 475.02 INR. Average cost of antipsychotics per prescription was 208.1 INR.Conclusions: The present study provides valuable insight into the overall pattern of antipsychotic drugs prescribed in patients suffering from different psychiatric illnesses and mental health disorders and the principles of rational prescribing were followed in accordance with the various drug use indicators mentioned by WHO.

Cost Analysis for Inpatient Treatment of Recurrent Depressive Disorder in Russia

ObjectivesTo estimate costs of pharmacotherapy of recurrent depressive disorder (RDD) in a hospital-based care. MethodsIn the study, we analyzed the real-world practice in hospital-based care and the costs of RDD pharmacotherapy. A total of 119 case histories of patients who received a diagnosis of RDD and were hospitalized in 2017 were retrospectively analyzed. The study examined sociodemographic data, clinical and economic data, the frequency of prescribing medications, and medical expenses per 1 hospitalization and per day. The sample (N = 119) was divided into 3 groups according to the International Classification of Diseases-10th Revision code and the severity of the disease. The cost conversion factor was 1 euro equals 89.92 rubles. ResultsAntidepressants and antipsychotic drugs prevailed in the structure of prescriptions (32% and 36%, respectively). Antidepressants had the largest share in the total cost structure (about 41%), while the total cost of antidepressants and antipsychotics reached a total of 70%. Less than half of the costs were drugs included in the Russian RDD hospital treatment standard. The most expensive group in terms of pharmacotherapy costs per patient was the group “patients with RDD of moderate severity” (F33.1)—€61.1 ± 92.0 per case of hospitalization; this diagnosis was made in 80% of hospitalized patients. ConclusionsAssessment of real-world practices and costs of treatment of patients with RDD allows for more widespread implementation of management methods that allow making a choice in favor of more cost-effective drugs for the treatment of RDDs in Russia.

PND116 EXAMINE THE SPENDING AND UTILIZATION PATTERNS OF SECOND-GENERATION ANTIPSYCHOTICS BASED ON MEDICAID CLAIMS DATABASE

Antipsychotics have been a major driver of Medicaid prescription drug expenditure, mostly due to high cost and utilization of atypical antipsychotics. The study objective is to describe and evaluate the trends of atypical antipsychotics’ expenditure, utilization and price. A retrospective time-series trend analysis was conducted. The primary data source was the National Medicaid Pharmacy summary claim files collected by the Center for Medicaid/Medicare Services from 1991 to 2017. The quarterly reimbursement amount, number of prescriptions (Rx), reimbursement per prescription and per unit (proxy of drug price) figures were constructed for each branded and generic atypical antipsychotic such as olanzapine, risperidone, quetiapine, aripiprazole, and ziprasidone. The trends were compared between branded and generic drugs in order to assess the impact of generic entry. The annual percentage changes were calculated for reimbursement, utilization, and price.. Total Medicaid spending on atypical antipsychotics increased from $16 million in 1991 to $5.5 billion in 2005, averaged a 59% growth rate. The utilization also increased from 172 thousand Rx to over 21 million Rx in 2005. Post-2006 period saw a sharp decline in both uptake and spending, which bottomed out at $3.6 billion reimbursed and 10.7 million Rx dispensed in 2008, before slowly recovered. Despite the percentage of antipsychotics Rx dispensed as generics exploded from 12% in 2008 to 89% in 2017, the majority of expenditures were driven by branded medications, accounting for over 83%, driven by increased price per Rx. Use of generic drugs grew in marketshare, but low impact on the price of existing branded drugs. Outside of cost, providers and patients’ preferences, off-label usage, FDA warnings and lawsuits are all important factors impacted spending and utilization of this class of drugs.

Cost variability of antipsychotics according to pharmaceutical establishments in Lima, Peru.

The objectives of the study were to determine the cost variability of antipsychotics in public (hospi tals) and private pharmaceutical establishments (pharmacies and clinics), calculate the cost variability of antipsychotics between establishments and estimate the cost of monthly maintenance treatment with antipsychotics. A cost analysis study was performed, unit costs of antipsychotics were obtained from the Peruvian Pharmaceutical Products Observatory. The results show that the cost variability of antipsycho tics was greater in pharmacies and clinics than in hospitals, and the analysis of cost variability between pharmaceutical establishments showed that the cost of an antipsychotic in a pharmacy and clinic was 1.3 to 140 times and 2.8 to 124 times, respectively, the cost of the drug in a hospital. The cost of monthly maintenance treatment varied from S/3 to S/2130 according to the drug and pharmaceutical establish ment.

The pharmacoeconomic efficacy of lurasidone in the treatment of schizophrenia

To conduct a comprehensive pharmacoeconomic evaluation of lurasidone for the treatment of patients with schizophrenia under Russian healthcare system conditions and inclusion in EDL (Essential Drugs List) and Medication List for the Certain Categories of Citizens. A retrospective study of lurasidone in the treatment of patients with schizophrenia was performed. Methods of pharmacoeconomic analysis were: cost analysis, budget impact analysis and cost-effectiveness analysis. Use of lurasidone for the treatment of patients with schizophrenia requires 50.04% less costs than the use of paliperidone and 46.69% less costs than the use of sertindole allowing to provide additional therapies to 100.1 and 87.6% of patients, respectively. The cost minimization analysis results are stable when prices fluctuate in the range of ±30%. Considering the current volume of antipsychotic drug supply, replacing 100% of paliperidone with lurasidone from the first year will reduce the cost of antipsychotics for patients who received paliperidone by 39.79 or by 360.81 million rubles over 3 years. Replacing 100% of sertindole with lurasidone from the first year will reduce the cost of antipsychotics for patients who received sertindole by 37.21 or 173.87 million rubles over 3 years. The results of the budget impact analysis are resistant to changes in prices for compared drugs in a wide range. Lurasidone is a more effective drug for treatment of schizophrenia from a pharmacoeconomic point of view in comparison with paliperidone and sertindole. With comparative efficacy with paliperidone and sertindole the use of lurasidone can significantly reduce the burden on budget of state programs of compensation for certain categories of citizens.

Literature review and economic evaluation of oral and intramuscular ziprasidone treatment among patients with schizophrenia in China

BackgroundOver 10 million Chinese are affected by schizophrenia. The annual cost of schizophrenia in China was estimated at US$2586 per patient.AimsThe study has two aims: (1) to conduct a targeted...

Costs in the Treatment of Schizophrenia in Adults Receiving Atypical Antipsychotics: An 11-Year Cohort in Brazil

BackgroundSchizophrenia is associated with significant economic burden. In Brazil, antipsychotic drugs and outpatient and hospital services are provided by the Brazilian National Health System (SUS) for patients with schizophrenia. However, few studies capture the cost of managing these patients within the Brazilian NHS. This is important to appraise different management approaches within universal healthcare systems.ObjectiveOur objective was to use real-world data to describe the costs associated with the treatment of schizophrenia in adults receiving atypical antipsychotics in Brazil from 2000 to 2010.MethodsWe integrated three national databases for adult patients with schizophrenia receiving one or more atypical antipsychotics. We assessed only direct medical costs and the study was conducted from a public-payer perspective. A multivariate log-linear regression model was performed to evaluate associations between costs and clinical and demographic variables.ResultsWe identified 174,310 patients with schizophrenia, with mean ± standard deviation (SD) annual costs of $US1811.92 ± 284.39 per patient. Atypical antipsychotics accounted for 79.7% of total costs, with a mean annual cost per patient of $US1578.74 ± 240.40. Mean annual costs per patient were $US2482.90 ± 302.92 for psychiatric hospitalization and $US862.96 ± 160.18 for outpatient psychiatric care. Olanzapine was used by 47.7% of patients and represented 62.8% of the total costs of atypical antipsychotics. Patients who used clozapine had the highest mean annual cost per patient for outpatient psychiatric care and psychiatric hospitalization.ConclusionsAtypical antipsychotics were responsible for the majority of the schizophrenia treatment costs, and psychiatric hospitalization costs were the highest mean annual cost per patient. Authorities should ensure efficient use of atypical antipsychotics and encourage outpatient psychiatric care over psychiatric hospitalization where possible.Electronic supplementary materialThe online version of this article (10.1007/s40258-018-0408-4) contains supplementary material, which is available to authorized users.

PMH28 - Cost Analysis Model for the Treatment of Acute Agitation Among Patients with Schizophrenia in China

To assess the healthcare resource utilization and cost associated with the inpatient treatment of short-acting intramuscular (IM) ziprasidone, oral risperidone + oral benzodiazepine, oral olanzapine, short-acting IM haloperidol, and electroconvulsive therapy (ECT) for the management of acute agitation among patients with schizophrenia in China from a hospital’s perspective. Cost measures included hospital room and board, antipsychotics, ECT, and medications for the management of extrapyramidal symptoms (EPS). Input for standard antipsychotic regimens and unit cost were obtained from literature. Hospital length of stay (LOS), utilization of ECT, and incidence of EPS were derived from the literature and supplemented/validated with a survey of 9 psychiatrists in China. Cost was presented in 2017 RMB (¥). Based on the survey, the average (range) estimated LOS was 29 (14-42) days with ziprasidone, 33 (15-60) days with risperidone + benzodiazepine, 32 (15-50) days with olanzapine, 35 (25-50) days with haloperidol, and 29 (12-42) days with ECT. The cost of antipsychotics was ¥1,261 with ziprasidone, ¥137 with risperidone + benzodiazepine, ¥913 with olanzapine, ¥210 with haloperidol; ECT treatment cost ¥1,585. The base-case analysis suggested that higher antipsychotic cost with ziprasidone was offset by savings with shorter LOS. Total costs including all the cost measures during the inpatient stay was the lowest with ziprasidone among all regimens (¥11,157 with ziprasidone, ¥11,406 with ECT, ¥11,422 with risperidone plus benzodiazepine, ¥11,711 with olanzapine, and ¥11,923 with haloperidol). The cost of antipsychotics and ECT accounted for 1.2% to 13.9% of the total cost. Varying LOS between the lower and upper bounds of the 95% confidence interval, total cost was comparable between these regimens. Overall, the cost for the management of acute agitation was similar between IM ziprasidone and other antipsychotics. Compared to other antipsychotics, higher medication cost of IM ziprasidone can be offset by savings with shorter hospital stay.

Antipsychotic prescription patterns and treatment costs of schizophrenia in northwestern Pakistan: A one-year observational study

Purpose: To evaluate the antipsychotic drugs most commonly prescribed for schizophrenia patients in Peshawar, Pakistan and to analyze the treatment costs associated with these drugs. Methods: One hundred patients diagnosed with schizophrenia were recruited from outpatient psychiatry departments in Peshawar, Pakistan and followed for one year. Demographic data were collected for each patient at the beginning of the study. A questionnaire was used to collect antipsychotic prescription information at 4, 8 and 12 months. The cost of antipsychotics was obtained from PharmaGuide, Pakistan. The cost associated with antipsychotic drug use was statistically analyzed using post hoc tests. Results: Of the patients who completed this study, 68.1 % were prescribed second-generation antipsychotic (SGA) drugs, 6.9 % first-generation antipsychotic (FGA) drugs, and 25.0 % a combination of SGAs and FGAs. Furthermore, 40.3 % of the patients who completed the study received antipsychotic monotherapy and 34.7 % antipsychotic polytherapy. In monotherapy, risperidone was the most commonly prescribed antipsychotic drug, used by 44.8 % of patients while in polytherapy, risperidone plus olanzapine was the most commonly prescribed combination, used by 32 % of patients. Switching of antipsychotic drugs was observed in 25 % of patients. The mean annual cost of antipsychotic therapy was US$79.90 (8079 Pakistani rupees). Risperidone treatment cost was US$60.30 (PakRs 6095), constituting 52 % of the total monotherapy cost. The cost of SGAs was significantly higher than the cost of FGAs (p < 0.05). Conclusion: The results provide policymakers with appropriate information necessary for managing pharmacotherapy plans for the treatment of schizophrenia. Keywords: Schizophrenia, Prescribing pattern, Antipsychotics, Cost analysis, Pharmacotherapy

Affordability of antipsychotic medications of respondents who are being managed for schizophrenia in Benin City

Introduction: The consequences of expensive antipsychotics medication can be two folds. One, patients can become more impoverished due to the spending of limited financial resources on the procurement of antipsychotics. Second, the high cost of antipsychotics maybe discouraging and therefore lead to poor adherence and therapeutic failure. The objective was to determine the levels of impoverishment, catastrophic expenditure and the number of days the least paid government worker will have to work due to out-of-pocket (OOP) payments of antipsychotics in a sample of patients receiving treatment for schizophrenia in Benin City. Methods: A community-based cross-sectional survey amongst respondents who are being managed for schizophrenia was conducted using a two-stage cluster sampling procedure. Outcome measures were poverty headcount ratio, poverty gap, catastrophic expenditure and the number of days the least paid government worker will have to work due to OOP payments for antipsychotics. Results: Schizophrenics receiving olanzapine, risperidone, haloperidol, trifluoperazine or chlorpromazine medication to manage their psychiatric condition are being further impoverished by 11.1%, 7.4%, 3.7%, 3.7% and 1.9%, respectively, at the risk of catastrophic expenses by 70%, 64%, 28%, 28% and 34%, respectively, while that of number of days the least paid government worker will have to work to get their drugs were 1.8 day, 1.35 day, 0.15 day, 0.15 day, 0.21 day, respectively. Conclusion: Antipsychotics such as olanzapine and risperidone are far less affordable than chlorpromazine, haloperidol and trifluoperazine.

Geographic Distribution of Antipsychotic Use in Medicare Part D Patients

Purpose: To determine if there is a geographic variation in antipsychotic prescribing in Medicare recipients in 10 US divisions.&#x0D; Methods: Data was collected in the Microsoft Excel format from the Medicare Provider Utilization and Payment Data: Part D Prescriber Public Use File for 2013 CMS data. Antipsychotics were sorted and downloaded into separate excel formats. The states were separated into the 10 geographic according to the US Census Bureau to identify prescribing trends. The primary endpoint was to determine the difference in the rates of CMS Medicare Part D utilizers who had antipsychotic prescriptions in each of the 10 geographic divisions. The rate of antipsychotic prescribing was calculated by determining the number of prescription claims for each antipsychotic for the division and dividing by the number of people utilizing Medicare Part D in each division. Data was converted to SPSS (version19, Armonk, NY) for further analysis. ANOVA was used to compare the differences.&#x0D; Results: Approximately 35 million claims were included in the data set. Antipsychotics comprised 4.75% of the total spending on medications for Medicare Part D. New England was found to have the highest rate of claims at 0.83. No statistically significant differences in the rate of antipsychotic prescribing across geographic regions was observed; however, a statistically significant difference was observed for total claims (P&lt;0.001) and total antipsychotic costs (P&lt;0.017) across regions.&#x0D; Conclusion: Additional studies need to be conducted to determine if there is a difference in antipsychotic prescribing in the United States.&#x0D; Conflict of Interest&#x0D; We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties.&#x0D; &#x0D; Type: Student Project

Geographic Distribution of Antipsychotic Use in Medicare Part D Patients

Purpose: To determine if there is a geographic variation in antipsychotic prescribing in Medicare recipients in 10 US divisions. Methods: Data was collected in the Microsoft Excel format from the Medicare Provider Utilization and Payment Data: Part D Prescriber Public Use File for 2013 CMS data. Antipsychotics were sorted and downloaded into separate excel formats. The states were separated into the 10 geographic according to the US Census Bureau to identify prescribing trends. The primary endpoint was to determine the difference in the rates of CMS Medicare Part D utilizers who had antipsychotic prescriptions in each of the 10 geographic divisions. The rate of antipsychotic prescribing was calculated by determining the number of prescription claims for each antipsychotic for the division and dividing by the number of people utilizing Medicare Part D in each division. Data was converted to SPSS (version19, Armonk, NY) for further analysis. ANOVA was used to compare the differences. Results: Approximately 35 million claims were included in the data set. Antipsychotics comprised 4.75% of the total spending on medications for Medicare Part D. New England was found to have the highest rate of claims at 0.83. No statistically significant differences in the rate of antipsychotic prescribing across geographic regions was observed; however, a statistically significant difference was observed for total claims (P&lt;0.001) and total antipsychotic costs (P&lt;0.017) across regions. Conclusion: Additional studies need to be conducted to determine if there is a difference in antipsychotic prescribing in the United States. Conflict of Interest We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties. &nbsp; Type:&nbsp;Student Project

Impact of regulatory measures on antipsychotics drug consumption in Castilla y León, Spain

ObjectivesAntipsychotics are currently used to treat different diseases; even some off-labelled conditions are treated with this medication. Consumption and cost of antipsychotic drugs sharply increased in Spain after second-generation drugs were marketed; several regulatory measures were adopted to curb this trend. The aim of this study was to examine the impact of these measures upon the use and cost of antipsychotics. Study designStudy of drug use (SDU) from 1995 to 2012. Consumption and cost data were obtained from the CONCYLIA database; this database contains the retail community pharmacies sales of medicinal products reimbursed by the National Health System in Castilla y León (Spain). MethodsData are presented as defined daily doses per 1000 inhabitants per day (DID) and day treatment cost (DTC). ResultsFirst-generation antipsychotics prescriptions gradually decreased from 3.0 to 1.8 DID; meanwhile, prescriptions for second-generation antipsychotics considerably increased from 0.3 to 9.9 DID. The use of risperidone dropped after the marketing of its structural derivative paliperidone with a similar efficacy but with a substantially higher cost per day. In 2011 and thereafter, patients in Spain began to pay a part of the medications cost, but this did not decrease antipsychotics consumption. Global cost of antipsychotics only began to fall after measures were adopted to lower the price of medicines because of the economic collapse in Spain after May 2010. ConclusionSeveral health policy measures have tried to reduce antipsychotics consumption in Spain, special ways of dispensing, marketing of generic drugs and special economic measures for patients. These measures eventually failed to avoid the increase in antipsychotics use. The cost only dropped when lowering prescription drug prices took place.

Trends in the use and cost of antipsychotics among older adults from 2007 to 2013: a repeated cross-sectional study.

Recently, several new atypical antipsychotic agents have been introduced in Ontario, and regulatory warnings have been issued regarding use of atypical antipsychotics in older adults. We sought to establish the impact of newer atypical antipsychotics on prescribing rates and costs. We performed a population-based cross-sectional study of Ontario adults aged 65 years or more using atypical antipsychotics from Jan. 1, 2007, to Mar. 31, 2013. These people have universal access to publicly funded drugs through the Ontario Health Insurance Plan and the Ontario Drug Benefit. We conducted time-series analysis to assess the impact of the introduction of new atypical antipsychotics on rates of use of atypical antipsychotics and associated expenditures. Rates of atypical antipsychotic use increased following the introduction of new agents in 2009, from 27.6 users per 1000 older adults in the third quarter of 2009 to 29.1 users per 1000 older adults at the end of the study period (p = 0.04). Although prescribing rates for the newer atypical agents (paliperidone, ziprasidone and aripiprazole) remained low relative to their older counterparts (risperidone, olanzapine and quetiapine), rates of aripiprazole use rose to 1.0 user per 1000 older adults by the end of the study period. The proportion of prescriptions that were for brand-name agents fell from 57.5% in the second quarter of 2007 to 6.1% in the second quarter of 2009, and then rose to 11.7% by the end of the study period. By the first quarter of 2013, newer atypical antipsychotic agents were used by 4.4% of atypical antipsychotic users but accounted for 14.1% ($1.2 million of $8.5 million) of atypical antipsychotic expenditures. Although the overall prevalence of use of new atypical antipsychotic agents remains low, their introduction has led to increased prescribing of this class of drugs in older adults. Given the potential cost implications, further study of these trends would be prudent.

Trends in Use and Cost of Second-Generation Antipsychotics Among Children and Teens in Indiana Medicaid, 2004-2012.

To replicate and extend a study by the Agency for Healthcare Research and Quality (AHRQ) and Rutgers on antipsychotic use among youths in Medicaid, the authors analyzed Indiana Medicaid claims from 2004 to 2012, extending the earlier study by focusing on second-generation antipsychotics, including both fee-for-service (FFS) and non-FFS patients, and analyzing cost trends. The authors evaluated the impact of several Indiana Medicaid policy changes on medication utilization and cost among children enrolled for at least one month during 2004-2012 (N=683,716-793,637), using an exhaustive antipsychotic list to search the database. Annual utilization rates for antipsychotics were 2%-3% but were much higher among foster children (10%-15%). Policies implemented in 2007 or later were associated with a significant plateauing of utilization in 2008-2012. Growth of second-generation antipsychotic utilization and costs was similar to trends described in the AHRQ-Rutgers study. Several containment strategies appeared effective in addressing these trends.

Time Series Analysis on the Impact of Generic Substitution and Reference Pricing on Antipsychotic Costs in Finland

ObjectivesTo analyze the medium- to long-term impact of generic substitution and the reference price system on the daily cost of antipsychotics in Finland. The additional impact of reference pricing over and above previously implemented generic substitution was also assessed. MethodsAn interrupted time series design with a control group and segmented regression analysis was used to estimate the effect of the implementation of generic substitution and the reference price system on the daily cost of antipsychotics. The data have 69 monthly values of the average daily cost for each of the studied antipsychotics: 39 months before and 30 months after the introduction of reference pricing. For one of the studied antipsychotic, the time before the introduction of reference pricing could be further divided into time before and after the introduction of generic substitution. ResultsAccording to the model, 2.5 years after the implementation of reference pricing, the daily cost of the studied antipsychotics was 24.6% to 50.6% lower than it would have been if reference pricing had not been implemented. Two and a half years after the implementation of the reference price system, however, the additional impact of reference pricing over and above previously implemented generic substitution was modest, less than 1 percentage point. ConclusionsAlthough the price competition induced by reference pricing decreased the prices of antipsychotics in Finland in the short-term, the prices had a tendency to stagnate or even to turn in an upward direction in the medium- to long-term. Furthermore, the additional impact of reference pricing over and above previously implemented generic substitution remained quite modest.

The impact of antipsychotic polytherapy costs in the public health care in Sao Paulo, Brazil.

IntroductionGuidelines for the treatment of psychoses recommend antipsychotic monotherapy. However, the rate of antipsychotic polytherapy has increased over the last decade, reaching up to 60% in some settings. Studies evaluating the costs and impact of antipsychotic polytherapy in the health system are scarce.ObjectiveTo estimate the costs of antipsychotic polytherapy and its impact on public health costs in a sample of subjects with psychotic disorders living in residential facilities in the city of Sao Paulo, Brazil.MethodA cross-sectional study that used a bottom-up approach for collecting costs data in a public health provider´s perspective. Subjects with psychosis living in 20 fully-staffed residential facilities in the city of Sao Paulo were assessed for clinical and psychosocial profile, severity of symptoms, quality of life, use of health services and pharmacological treatment. The impact of polytherapy on total direct costs was evaluated.Results147 subjects were included, 134 used antipsychotics regularly and 38% were in use of antipsychotic polytherapy. There were no significant differences in clinical and psychosocial characteristics between polytherapy and monotherapy groups. Four variables explained 30% of direct costs: the number of antipsychotics, location of the residential facility, time living in the facility and use of olanzapine. The costs of antipsychotics corresponded to 94.4% of the total psychotropic costs and to 49.5% of all health services use when excluding accommodation costs. Olanzapine costs corresponded to 51% of all psychotropic costs.ConclusionAntipsychotic polytherapy is a huge economic burden to public health service, despite the lack of evidence supporting this practice. Great variations on antipsychotic costs explicit the need of establishing protocols for rational antipsychotic prescriptions and consequently optimising resource allocation. Cost-effectiveness studies are necessary to estimate the best value for money among antipsychotics, especially in low and middle income countries.

PMH41 - Cost-Effectiveness of Asenapine Versus Atypical Antipsychotics Used in Turkey in the Treatment of Bipolar I Disorder

Asenapine is a new atypical antipsychotic approved in Turkey for the treatment of bipolar I disorder (BD-I) and schizophrenia. Asenapine has demonstrated comparable antimanic efficacy over olanzapine in a head-to-head study. 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 the treatment of BD-I compared with the most widely used atypical antipsychotics 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. Risks of metabolic syndrome after 52 weeks of treatment 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 BD-I. Compared to olanzapine, quetiapine, aripiprazole, risperidone and paliperidone (all genericized), asenapine was associated with incremental total costs of 2418 TL, 1786 TL, 804 TL and 877 TL; and associated with incremental total number of diabetes & CVD avoided of 0.054, 0.038, 0.010 and 0.037 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.

PMH40 - Cost-Effectiveness of Asenapine Versus Atypical Antipsychotics Used in Turkey in the Treatment of Schizophrenia

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.

Long-term cost-effectiveness of atypical antipsychotics in the treatment of adults with schizophrenia in the US.

BackgroundThe purpose of this study was to evaluate the long-term cost-effectiveness (including hospitalizations and cardiometabolic consequences) of atypical antipsychotics among adults with schizophrenia.MethodsA 5-year Markov cohort cost-effectiveness model, from a US payer perspective, was developed to compare lurasidone, generic risperidone, generic olanzapine, generic ziprasidone, aripiprazole, and quetiapine extended-release. Health states included in the model were patients: on an initial atypical antipsychotic; switched to a second atypical antipsychotic; and on clozapine after failing a second atypical antipsychotic. Incremental cost-effectiveness ratios (ICERs) assessed incremental cost/hospitalization avoided. Effectiveness inputs included discontinuations, hospitalizations, weight change, and cholesterol change from comparative clinical trials for lurasidone and for aripiprazole, and the Clinical Antipsychotic Trials of Intervention Effectiveness for other comparators. Atypical antipsychotic-specific relative risk of diabetes obtained from a retrospective analysis was used to predict cardiometabolic events per Framingham body mass index risk equation. Mental health costs (relapsing versus nonrelapsing patients) and medical costs associated with cardiometabolic consequences (cardiovascular events and diabetes management) were obtained from published sources. Atypical antipsychotic costs were estimated from Red Book® prices at dose(s) reported in clinical data sources used in the model (weighted average dose of lurasidone and average dose for all other comparators). Costs and outcomes were discounted at 3%, and model robustness was tested using one-way and probabilistic sensitivity analyses.ResultsZiprasidone, olanzapine, quetiapine extended-release, and aripiprazole were dominated by other comparators and removed from the comparative analysis. ICER for lurasidone versus risperidone was $25,884/relapse-related hospitalization avoided. At a $50,000 willingness-to-pay threshold, lurasidone has an 86.5% probability of being cost-effective, followed by a 7.2% probability for olanzapine, and 6.3% for risperidone. One-way sensitivity analysis showed the model is sensitive to lurasidone and generic risperidone hospitalization rates.ConclusionGeneric risperidone is the least costly atypical antipsychotic. Lurasidone is more costly and more effective than risperidone and is cost-effective at willingness-to-pay thresholds of greater than $25,844 per hospitalization avoided. The favorable cost-effectiveness of lurasidone is driven by its clinical benefits (eg, efficacy in preventing hospitalizations in patients with schizophrenia) and its minimal cardiometabolic adverse effect profile.