Cost-effectiveness of olanzapine in the first-line treatment of schizophrenia in China

Objectives: This study aimed to analyze (1) the cost-effectiveness of olanzapine orally disintegrating tablet (ODT) compared to olanzapine standard oral tablet (SOT) and (2) the cost-effectiveness of olanzapine-SOT compared to aripiprazole-SOT for patients with schizophrenia in China.

Methods: A microsimulation model was adapted from a healthcare payers’ perspective. The model ran over a 1-year time horizon, using quarterly cycles. The costs of adverse events were acquired through a clinical expert panel. The average bidding prices in China of olanzapine-ODT, olanzapine-SOT, aripiprazole-SOT, and other switch alternatives were used. Inpatient and outpatient medical costs were sourced from the Urban Employee Basic Medical Insurance database in Tianjin. Additionally, adherence, efficacy, safety, and utility data were taken from the literature. Uncertainty of parameters were assessed through one-way and probabilistic sensitivity analyses.

Results: The total annual costs per patient in aripiprazole-SOT arm, olanzapine-SOT arm, and olanzapine-ODT arm are USD 2,296.05, USD 1,940.05, and USD 2,292.81, respectively. The average number of relapses per patient in 1 year in the aripiprazole-SOT arm, olanzapine-SOT arm, and olanzapine-ODT arm, are 0.734, 0.325, and 0.198, respectively. The quality-adjusted life years (QALYs) gained per patient in 1 year in the aripiprazole-SOT arm, olanzapine-SOT arm, and olanzapine-ODT arm are 0.714, 0.737, and 0.758, respectively. Consequently, (1) the incremental cost-effectiveness ratios (ICERs) of administrating olanzapine-ODT over olanzapine-SOT are USD 2,791.96 per relapse avoided and USD 16,798.39 per QALY gained; and (2) the ICERs of using olanzapine-SOT over aripiprazole-SOT are USD –870.39 per relapse avoided and USD –15,477.93 per QALY gained. All ICERs are under the willingness-to-pay threshold in China of USD 25,772.67. The sensitivity analyses confirmed the robustness of the results.

Conclusion: As the first-line treatment for schizophrenia in China, olanzapine-ODT is cost-effective compared to olanzapine-SOT and olanzapine-SOT is cost-effective compared to aripiprazole-SOT.     

Cost-utility of risperidone compared with standard conventional antipsychotics in chronic schizophrenia

SUMMARY

The high costs and the efficacy of risperidone warrant a systematic pharmacoeconomic evaluation in order to assess its relative cost-utility. The purpose of this study was to evaluate the costs and utilities of treatment in chronic schizophrenia. To achieve this, a cost-utility analysis, which compared risperidone to haloperidol and two depot antipsychotics: haloperidol decanoate and fluphenazine decanoate was conducted. A deterministic decision analysis was used to model chronic schizophrenia over one year. Probabilities were obtained from clinical trials for each medication that were combined using a random effects single arm meta-analysis. Utility values for different health states were obtained by patient interview. A government payer perspective was adopted for this analysis.

The study results demonstrate that risperidone is a dominant therapy in this baseline analysis since it is associated with the lowest overall cost and highest number of quality-adjusted life-years (QALYs). Compared with haloperidol, risperidone might save $6,510 (CAN$) per year while producing 0.04 more QALYs per average patient.     

Pharmacoeconomic analysis of the treatment of schizophrenia with quetiapine,olanzapine, risperidone or haloperidol in Spain

Summary

The study objective was to compare the costs of the treatment of schizophrenia with quetiapine (QUE), olanzapine (OLA), risperidone (RIS) or haloperidol (HAL) and those of the secondary effects (SE) associated. A cost-effectiveness analysis, using a Markov process, was used.The time horizon was 12 months.The study population comprised Spanish adult schizophrenic patients.The NHS perspective was taken (direct costs).The costs of several SE of medication were analysed. Use of resources and costs were calculated following the recommendations of the Spanish Psychiatric Society and other sources.

The monthly rates of the onset of SE with each medicine were calculated using a meta-analysis and systematic review of the literature.

A simple univariate sensitivity analysis was performed. QUE is as efficacious as OLA and RIS, but apparently leading to fewer cases of extrapyramidal syndrome and sexual dysfunction, with lower costs. QUE is better tolerated than HAL, but with higher costs.     

Cost-effectiveness of amisulpride compared with risperidone in patients with schizophrenia

SUMMARY

Amisulpride is an atypical antipsychotic, which has demonstrated efficacy across the range of symptoms of schizophrenia. This study compares the treatment costs of amisulpride (including drug costs, hospital costs, and costs of clinician and nurse visits) with those of risperidone over a 6-month treatment period, from the perspective of the UK National Health Service. Resource utilisation data were collected alongside an international, multicentre clinical trial comparing amisulpride (400-1000 mg/day) with risperidone (4-10 mg/day) in 198 patients with schizophrenia. As this trial demonstrated that amisulpride had at least equivalent efficacy to risperidone, the present study was a cost-minimisation analysis. Unit cost data for the UK were obtained from published sources and applied to the clinical data to calculate direct treatment costs. Amisulpride was associated with lower drug acquisition costs and lower resource utilisation costs than risperidone, although the differences did not reach statistical significance. Overall, the average total cost per patient for 6 months of treatment with amisulpride (£12,673; 95% CI: 10,628,14,717) was £2,145 less than for risperidone (£14,818; 95% CI: 12,323,17,312). These findings are similar to those of a previous study that compared the treatment costs of amisulpride with those of haloperidol, and found that

amisulpride was associated with significantly lower direct treatment costs than haloperidol. Amisulpride is a valuable treatment option in patients with schizophrenia.     

Reduction in costs of inpatient stay associated with clozapine treatment: A retrospective study

Summary

Clozapine is an atypical antipsychotic drug used to treat the 10-25% of patients who suffer from schizophrenia who are treatment resistant or intolerant to standard antipsychotic drug treatment. A major issue associated with treatment is the high cost of the drug compared to standard antipsychotic drug treatment. Research carried out to date has suggested that despite the high cost of clozapine, it is overall a cost-effective treatment. This contention is based on the findings described elsewhere that clozapine treatment is associated with a dramatic decrease in psychiatric inpatient stay.

There are many ethical difficulties associated with a prospective double-blind controlled trial of clozapine treatment. We have therefore reported on a retrospective audit. A retrospective analysis was carried out by the examination of computerised patient records to determine if clozapine treatment had been associated with a reduction in psychiatric inpatient stay. Also examined was whether clozapine treatment had been associated with an overall shift from intensive therapeutic ward usage.

For example, patients are moved from intensive care and acute wards to wards with less intensive therapeutic input such as continuing care and rehabilitation wards. The inpatient stay details for 76 patients prescribed clozapine since early 1991 were examined before and after clozapine treatment commenced. The main problem with this retrospective analysis is that without any control group observed over the same time period, it is very difficult to assess how much of the decrease in bed usage is related to either the natural history of the disease and/or to changes in bed use over time associated with changes in mental health service provision and the development of community facilities.

Psychiatric inpatient stay decreased by a statistically non-significant average of 13.2 days (6%) in the first year of treatment (p=0.7692), a non-significant average of 34 days (15%) in the second year of treatment (p=0.0669), a significant average of 38.4 days (17%) in the third year of treatment (p=0.0007) and again by a significant average of 51.2 days (22%) in the fourth year of treatment (p=0.0011).

The average cost per inpatient bed-day for the main psychiatric hospital in the Health Board's area is £90.86 (based on 100% occupancy rate, 1994/95 prices). The reduction in bed days identified was equivalent to a saving of £1,200 per patient in the first year of treatment, £3,090 per patient in the second year, £3,490 per patient in the third year and £4,652 per patient in the fourth year. The average annual cost of clozapine per patient is approximately £2,500.

Clozapine treatment was also associated with a shift from intensive care and acute ward inpatient usage to continuing care and rehabilitative ward usage. In the year prior to clozapine treatment intensive care and acute ward stay accounted for 72.7% of total inpatient stay. In the first year of treatment this proportion decreased to 63.7%, in the second year to 39.5%, in the third year to 31.8% and in the fourth year to 24.6%. This represented potential savings of £500,000 per annum.

Overall, the data generated from this study indicated that clozapine treatment is associated with both a reduction in psychiatric bed usage and a shift to less therapeutically intensive care wards. However, the decrease identified is not as dramatic as the reduction quoted elsewhere in the literature. These findings provide useful costing information to support the view that clozapine is a cost-saving or cost-neutral treatment in terms of the provision of psychiatric services in the UK. However, the costs associated with the increased use of community services by the study group were not identified in this review. In order to establish whether or not clozapine is cost saving overall compared to standard antipsychotic treatment it would have been necessary to identify all costs, including the whole range of community costs, before and after treatment commenced.     

Cost analysis of a disease management programme for adult Medicaid clients with schizophrenia

Summary

This investigation assessed changes in direct medical costs, from the perspective of a public payer, associated with a comprehensive, field-based disease management programme for adult Medicaid clients with schizophrenia in the US State of Colorado.

A propensity score-matching algorithm was employed in this retrospective analysis owing to the inherent non-randomisation of enrollees. Of the 126 clients initially enrolled, 73 (58%) remained within the programme continuously for 6–12 months.

These participants were associated with 30% lower overall per member per month medical costs (p<0.001), although no differences were noted for overall pharmacy costs. Provision of the disease management programme was through an external vendor and cost $31,250 per month regardless of the number enrolled.

Future research should seek to assess long-term clinical, humanistic and economic outcomes in this population and to develop methods that increase programme participation.     

Medication adherence and discontinuation of long-acting injectable versus oral antipsychotics in patients with schizophrenia or bipolar disorder

Aims: To examine medication adherence and discontinuation in two separate groups of patients with schizophrenia or bipolar disorder (BD), who began receiving a long-acting injectable antipsychotic (LAI) versus those who changed to a different oral antipsychotic monotherapy.

Materials and methods: The Truven Health Analytics MarketScan Multi-State Medicaid claims database was used to identify patients with schizophrenia; Truven Health Analytics MarketScan Commercial and Medicaid claims databases were used to identify patients with BD. The analyses included adult patients (≥18 years) who either began receiving an LAI (no prior LAI therapy) or changed to a different oral antipsychotic (monotherapy). The first day of initiating an LAI or changing to a new oral antipsychotic was the index date. Linear and Cox regression models were conducted to estimate medication adherence (proportion of days covered [PDC]) and time to medication discontinuation (continuous medication gap ≥60 days), respectively. Models adjusted for patient demographic and clinical characteristics, baseline medication use, and baseline ED or hospitalizations.

Results: Patients with schizophrenia (N?=?5638) who began receiving LAIs had better medication adherence (5% higher adjusted mean adherence) during the 1 year post-index period and were 20% less likely to discontinue their medication during the entire follow-up period than patients who changed to a different oral antipsychotic monotherapy, adjusting for differences between LAI users and oral users. Similarly, patients with BD (N?=?11,344) who began receiving LAIs also had 5% better medication adherence and were 19% less likely to discontinue their medication than those using oral antipsychotics.

Limitations: Clinical differences unmeasurable in this database may have been responsible for the choice of LAI versus oral antipsychotics, and these differences may be responsible for some of the adherence advantages observed.

Conclusions: This real-world study suggests that patients with schizophrenia or BD who began receiving LAIs had better medication adherence and lower discontinuation risk than those who changed to a different oral antipsychotic monotherapy.     

An economic evaluation of tofacitinib for the treatment of moderately-to-severely active ulcerative colitis: modeling the cost of treatment strategies in the United States

Abstract

Aims: To evaluate the cost differences between a treatment strategy including tofacitinib (TOFA) vs treatment strategies including adalimumab (ADA), golimumab (GOL), infliximab (IFX), and vedolizumab (VEDO) among all patients with moderate-to-severe ulcerative colitis (UC) (further stratified by patients naïve/exposed to tumor necrosis factor inhibitors [TNFis]).

Materials and methods: An Excel-based decision-analytic model was developed to evaluate costs from the perspective of a third-party US payer over 2 years. Efficacy and safety parameters were taken from prescribing information and published trials. All patients started induction therapy on the first treatment in the strategy and continued if efficacy criteria were met and no major adverse event occurred (in which cases they proceeded to the next treatment in the strategy).

Results: The cost per member per month (PMPM) of the TOFA–>IFX–>VEDO–>GOL strategy ($1.11) was lower than that of the ADA–>IFX–>VEDO–>GOL strategy ($1.34; Δ = $?0.23) among the TNFi-naïve population (n?=?204 patients out of a plan of one million members). Similarly, the use of TOFA before ADA (i.e. TOFA–>ADA–>IFX–> VEDO) was also associated with lower PMPM costs than the use of ADA before TOFA (i.e. ADA–>TOFA–>IFX–>VEDO): $1.15 vs $1.25 (Δ = $?0.10). Similar, and often larger, differences were observed in both the overall moderate-to-severe population and the TNFi-exposed population. Sensitivity analyses resulted in the same conclusions.

Limitations: Our model relied on efficacy data from prescribing information and published trials, which were not head-to-head and slightly differed with respect to methods. Additionally, our model used representative minor and major ADRs (and the associated costs) to represent toxicity management, which was a simplifying assumption.

Conclusions: This analysis, the first of its kind to evaluate TOFA vis-à-vis other advanced therapies in the US, suggests the early use of TOFA among both TNFi-naïve and TNFi-failure patients results in lower PMPM costs compared with other treatment alternatives.     

A comparison of treatment patterns,healthcare resource utilization,and costs among young adult Medicaid beneficiaries with schizophrenia treated with paliperidone palmitate or oral atypical antipsychotics in the US

Abstract

Background: Much of the burden associated with schizophrenia is attributed to its early onset and chronic nature. Treatment with once monthly paliperidone palmitate (PP1M) is associated with lower healthcare utilization and better adherence as compared to oral atypical antipsychotics (OAAs). This study aimed to evaluate real-world effectiveness of PP1M and OAA therapies among US-based adult Medicaid patients with schizophrenia, overall and among young adults aged 18–35 years.

Methods: Adult patients with a diagnosis of schizophrenia and at least two claims for PP1M or OAA between January 1, 2010 and December 31, 2014 were selected from the IBM Watson Health MarketScan Medicaid Database. Treatment patterns and healthcare resource utilization and costs were compared between PP1M and OAA treatment groups following inverse probability of treatment (IPT) weighting to adjust for potential differences. Utilization and cost outcomes were estimated using OLS and weighted Poisson regression models.

Results: After IPT weighting, the young adult PP1M and OAA cohorts were comprised of 3,095 and 3,155 patients, respectively. PP1M patients had a higher duration of continuous treatment exposure (168.2 vs 132.5 days, p?=?.004) and better adherence on the index medication (proportion of days covered ≥80%: 19.0% vs 17.1%, p?<?.049). Young adults treated with PP1M were 37% less likely to have an all-cause inpatient admission (odds ratio [OR]?=?0.63, 95% confidence interval [CI]?=?0.53–0.74) and 33% less likely to have an ER visit (OR?=?0.67, 95% CI?=?0.55–0.81) compared to OAA young adult patients, but 27% more likely to have an all-cause outpatient office visit (OR?=?1.27, 95% CI?=?1.02–1.56). PP1M patients incurred significantly lower medical costs as compared to OAA patients.

Conclusions: Medicaid patients with schizophrenia treated with PP1M have higher medication adherence and have fewer hospitalizations as compared to patients treated with OAAs. PP1M may lead to reduced healthcare utilization and improved clinical outcomes.     

博思清与维思通治疗精神分裂症的药物经济学分析

目的比较博思清与维思通治疗精神分裂症的成本-效果。方法对50例住院精神分裂症患者应用博思清与维思通进行治疗,疗程6周。采用成本-效果分析法对两组进行分析。结果博思清与维思通治疗精神分裂症的有效率分别为96.0%和92.0%,两者疗效无显著性差异(P>0.05),成本分别为638.16元和647.8元。结论博思清治疗精神分裂症疗效与维思通相当,但起效更快,博思清(阿立哌唑)治疗精神分裂症较经济。     

Comparing olanzapine and ziprasidone in the treatment of schizophrenia: a case study in modeling

SUMMARY

When a new drug is introduced to the market, the availability of head-to-head data for comparisons of annual cost and health outcomes with other drugs already on the market is usually insufficient. When only limited head-to-head data are available, one alternative is to perform preliminary modeling using data from the best available studies. In this paper, we synthesise data from the most comparable available studies to create a model to compare the annual costs and health outcomes when initiating treatment for schizophrenia with one of two antipsychotic drugs: olanzapine, which was launched in the United States (US) market in September 1996, and ziprasidone, which was approved by the US Food and Drug Administration (FDA) in February 2001. Annual treatment costs were determined by response and relapse rates as well as acquisition costs. The results indicate similar annual treatment costs (US$48,676 for olanzapine; US$48,873 for ziprasidone), despite the lower drug acquisition cost for ziprasidone. Annual health outcomes differed between the olanzapine and ziprasidone groups with 23.5% and 25.2% relapsed, 36.7 and 37.4 hospital days, and 60.0 and 60.1 EPS days in the olanzapine and ziprasidone groups respectively. A head-to-head naturalistic trial is needed to validate the results of this modeling exercise.     

造纸废水处理经济效益分析

造纸废水污染危害严重,是我国当前重点控制的主要污染源之一。从经济学角度出发分析了一个中型造纸企业投资建设废水处理设施所取得的一定的环境效益和经济效益,并从保护环境角度强调管理手段的重要性。     

An economic evaluation of the Baldrige National Quality Program

All federal programs are accountable for their use of public funds. This paper presents conservative estimates of the net social benefits associated with the Baldrige National Quality Award Program, established within the National Institute of Standards and Technology in 1987. On the basis of survey data from members of the American Society for Quality, we estimate cost savings benefits to members, extrapolate those benefits to the economy as a whole, and compare the benefits to the social costs associated with the Program. Our estimation method implies that the ratio of economy-wide benefits to social costs probably exceeds 207:1, supporting the hypothesis that the public investments in quality-standards infrastructure are worthwhile.     

Inpatient and outpatient rehabilitation for patients with rheumatoid arthritis: a clinical and economic assessment

Summary

The aim of this study was to compare inpatient and outpatient rehabilitation for patients with active rheumatoid arthritis from clinical and cost perspectives.

A single-centre, randomised trial design was used. Data were recorded at baseline, post treatment and at 6 months follow-up. The primary outcome measure was the Arthritis Impact Measurement Scale 2. Several other disease activity, functional and quality of life measures were also assessed (erythrocyte sedimentation rate, C-reactive protein, visual analogue scale for pain, early morning stiffness, tender and swollen joint count, grip strength, timed ‘Up and Go’ test and Schedule for the Evaluation of the Individual Quality of Life—Direct Weighting). All direct and indirect costs were measured. A total of 47 subjects were randomised to the study.

No sustained significant differences were detected between the two groups for the primary or secondary measures at the end of treatment or at follow-up. Total inpatient costs (€81,590) were more than three times higher than total outpatient costs (€25,450).     

Estimating the social cost of pesticide use: An assessment from acute poisoning in Brazil

The intensive use of pesticides in countries like Brazil has ignored structural and institutional shortfalls, such as the lack of workforce training for the new, difficult to implement technologies, and the institutional vulnerability of the environmental protection, health, and safety sectors. As a result we have “invisible” or social, environmental and health costs which end up being socialised with the farmer, in general, having no incentives to recognise and internalise them. This study is intended to review and develop this problem in the light of the Brazilian reality. To this end, we make use of an empirical exercise to illustrate estimation of the social cost associated with acute poisoning by pesticide using the PREVS/IBGE data (Harvest Forecast Research) in the state of Paraná, Brazil. The results suggest that, for maize, the costs of acute poisoning could represent 64% of the benefits of using herbicides and insecticides, and, in the best of hypotheses, when some risk factors are eliminated, they may reach 8% of the benefits of the use of these products. Similarly, when we examine future scenarios for five and ten years, we find less encouraging results, as in ten years the costs of acute poisoning could reach around 85% of the benefit of using insecticides and herbicides for maize. However, there is the encouraging news that, if preventive measures were taken during this time, the gains would be considerable, about 6.5 times greater. We conclude that an assessment of the real benefits involved with pesticides in Brazil is required, principally in regard to the smallholder, where farmers need more training in the use — or even the elimination — of these hazardous substances. There are sustainable technological options available which are economically efficient, especially if we consider the social, environmental and health costs. In this context it is worth highlighting the role of regulatory measures as a mechanism which can reorient generation of negative external costs through the reduction of current incentives in the socialisation of private costs.     

An economic analysis of consumer class actions in regulated industries

Regulation and consumer class actions can complement, duplicate, or oppose each other, depending, among others, on the leanings of regulatory objective functions towards the industry or consumers. In particular, pro-consumer regulators would like to see consumers benefit from class actions while pro-industry regulators would like to prevent regulated firms from being harmed by them. However, because pro-consumer regulators are already doing their best for consumers and pro-industry regulators their best for firms, they are both usually constrained in their policies. The result is that class actions tend to be less efficient under pro-consumer regulators and more efficient under pro-industry regulators.