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Applied Health Economics and Health Policy

, Volume 11, Issue 5, pp 509–521 | Cite as

Cost Effectiveness of Paliperidone Palmitate for the Treatment of Schizophrenia in Germany

  • Jan ZeidlerEmail author
  • Jörg Mahlich
  • Wolfgang Greiner
  • Stephan Heres
Original Research Article

Abstract

Background

Treatment with antipsychotic medication is an important element of relapse prevention in the management of schizophrenia, and can reduce inpatient stays. Recently, the long-acting atypical antipsychotic paliperidone long-acting injectable (PLAI), a once-monthly LAI antipsychotic, was approved for treatment of schizophrenia in Germany.

Objective

To estimate, based on a previously published model, the cost effectiveness of PLAI compared with other common antipsychotic treatment strategies in patients diagnosed with schizophrenia in Germany.

Methods

A Markov decision analytic model was adapted to the German healthcare system. The model considers the cost effectiveness for PLAI as a maintenance treatment for patients with schizophrenia from the payer perspective. The patients transition between eight health states on a monthly basis over a 5-year time horizon. As therapeutic strategies, PLAI, quetiapine, risperidone long-acting injections (RLAI), oral olanzapine, oral risperidone, zuclopenthixol decanoate, olanzapine long-acting injections (OLAI), oral typical and oral atypical were compared. Probability of relapse, level of adherence, side effects and treatment discontinuation were derived from the Swedish original model. Input factors regarding resource use and costs were estimated and adjusted for the German healthcare system. A probabilistic sensitivity analyses (PSA) using cost-effectiveness scatter plots was performed to visualize the robustness of the results.

Results

In base-case scenario, PLAI is superior to RLAI in gained quality-adjusted life-years (QALYs) and avoided relapses. Relative to all other treatment strategies, PLAI is more effective with regard to gained QALYs and avoided relapses but results in higher treatment costs over a 5-year horizon in base-case scenario. The results were tested in PSA. If a cost-effectiveness threshold of €30,000 is assumed, for example, PLAI can be considered to be cost effective compared with RLAI in about 92.5 % of cases regarding gained QALYs, and in 78.6 % of cases regarding avoided relapse. Compared with OLAI, in about 94.4 % of cases regarding gained QALYs and in 99.9 % of cases regarding avoided relapse, cost effectiveness can be considered. Comparing PLAI and zuclopenthixol decanoate, cost effectiveness can be assumed in about 90.4 % of cases regarding gained QALYs, and in all cases regarding avoided relapse.

Conclusions

PLAI dominates RLAI and compared with the other treatment strategies PLAI has shown to be more effective but results in higher costs in base-case scenario.

Keywords

Schizophrenia Quetiapine Paliperidone Probabilistic Sensitivity Analysis Paliperidone Palmitate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

Funding: This work was financially supported by an unrestricted grant from Janssen-Cilag GmbH.

Conflicts of interest

Jörg Mahlich is an employee of Janssen (Johnson & Johnson).

Stephan Heres has received honoraria from Janssen-Cilag, Sanofi-Aventis, Bristol-Myers-Squibb, Eli Lilly and Johnson & Johnson, and has accepted travel or hospitality payment from Janssen-Cilag, Sanofi-Aventis, Johnson & Johnson, Pfizer, Bristol-Myers-Squibb, AstraZeneca, Lundbeck, Novartis and Eli Lilly. Dr. Heres has participated in clinical trials sponsored or supported by Eli Lilly, Janssen Cilag, Johnson & Johnson, Bristol-Myers-Squibb, Otsuka, AstraZeneca, Lundbeck, Novartis, Servier, Pierre Fabre, Pfizer and Merck, and has also received honoraria from Janssen, Johnson & Johnson, Lundbeck, Eli Lilly and Roche for consultant services or participation in advisory boards.

Jan Zeidler and Wolfgang Greiner have no conflicts of interest.

Contribution

Jan Zeidler led the design of the study and was primarily responsible for collecting input parameters and calculating the model, as well as for drafting the article. He is guarantor for the overall content. Jörg Mahlich gave support in collecting input factors and drafting of the article. Wolfgang Greiner and Stephan Heres contributed to the conception and planning of the study, the definition and interpretation of input factors and drafting of the article for important intellectual content.

Supplementary material

40258_2013_50_MOESM1_ESM.docx (61 kb)
Supplementary material (DOCX 61 kb)

References

  1. 1.
    Robert Koch-Institut. Gesundheitsberichterstattung des Bundes: Heft 50—Schizophrenie (The Federal Health Monitoring System: issue 50—schizophrenia). Berlin: Robert Koch-Institut; 2010.Google Scholar
  2. 2.
    Rössler W, Salize J, Knapp M. Die Kosten der Schizophrenie (The costs of schizophrenia). Fortschr Neurol Psychiatr. 1998;66(11):496–504.PubMedCrossRefGoogle Scholar
  3. 3.
    Statistisches Bundesamt. Krankheitskostenrechnung (Cost of illness) [online]. https://www.gbe-bund.de (Accessed 4 Dec 2012).
  4. 4.
    Von der Schulenburg JM, Uber A, Höffler J, et al. Untersuchungen zu den direkten und indirekten Kosten der Schizophrenie (Studies on direct and indirect costs of schizophrenia). Gesundheitsökonomie & Qualitätsmanagement. 1998;3:81–7.Google Scholar
  5. 5.
    Kissling W, Höffler J, Seemann U, et al. Die direkten und indirekten Kosten der Schizophrenie (Direct and indirect costs of schizophrenia). Fortschr Neurol Psychiatr. 1999;67(1):29–36.PubMedCrossRefGoogle Scholar
  6. 6.
    Roick C, Killian R, Reinhold K, et al. Die indirekten Kosten schizophrener Psychosen (Indirect costs of schizophrenia). Gesundheitsökonomie & Qualitätsmanagement. 2001;6(2):36–43.CrossRefGoogle Scholar
  7. 7.
    Konnopka A, Klingberg S, Wittorf A, et al. Die Kosten der Schizophrenie in Deutschland: Ein systematischer Literaturüberblick (The cost of schizophrenia in Germany: a systematic review of the literature). Psychiatr Prax. 2009;36(5):211–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Klosterkötter J. Indizierte Prävention schizophrener Erkrankungen (Indicated prevention of schizophrenia). Dtsch Arztebl. 2008;105(30):A10532.Google Scholar
  9. 9.
    Kilian R, Roick C, Matschinger H, et al. Die Analyse von Kostenstrukturen im Bereich der Schizophreniebehandlung mit einem standardisierten Instrumentarium (The analysis of the cost structures of the treatment of schizophrenia by means of standardized assessment instruments). Psychiatr Prax. 2001;28(Suppl. 2):S102–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Salize HJ, Rössler W, Reinhard I. Kostenermittlung in einem fragmentierten psychiatrischen Versorgungssystem (Cost assessment in a fragmented psychiatric treatment system). Gesundheitswesen. 1996;Suppl. 1:10–7.Google Scholar
  11. 11.
    Osterheider M, Franken-Hiep K, Horn R. Gesamtkrankenkosten der Schizophrenie und monetäre Bewertung einer Rezidivprophylaxe am Beispiel eines Standard-Depot-Neuroleptikums (Flupentixoldecanoat) (Total illness costs of schizophrenia and monetary evaluation of prevention of recurrence exemplified by a standard depot neuroleptic (flupenthixol decanoate)). Psychiatr Prax. 1998;25(1):38–43.PubMedGoogle Scholar
  12. 12.
    Zeidler J, Slawik L, Fleischmann J, et al. Impact and costs of hospitalisation in schizophrenia [abstract]. Value Health. 2010;13(7):A449.CrossRefGoogle Scholar
  13. 13.
    Rummel-Kluge C, Schuster T, Peters S, et al. Partial compliance with antipsychotic medication is common in patients with schizophrenia. Aust N Z J Psychiatry. 2008;42(5):382–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Marder SR. Overview of partial compliance. J Clin Psychiatry. 2003;64(Suppl. 16):3–9.PubMedGoogle Scholar
  15. 15.
    Acosta FJ, Bosch E, Sarmiento G, et al. Evaluation of noncompliance in schizophrenia patients using electronic monitoring (MEMS) and its relationship to sociodemographic, clinical and psychopathological variables. Schizophr Res. 2009;107(2):213–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Willis M, Svensson M, Löthgren M, et al. The impact of schizophrenia-related hospital utilization and cost of switching to long-acting risperidone injections in Sweden. Eur J Health Econ. 2010;11(6):585–94.PubMedCrossRefGoogle Scholar
  17. 17.
    Tiihonen J, Haukka J, Taylor M, et al. A nationwide cohort study of oral and depot antipsychotics after first hospitalization for schizophrenia. Am J Psychiatry. 2011;168(6):603–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Grimaldi-Bensouda L, Rouillon F, Astruc B, et al. Does long-acting injectable risperidone make a difference to the real-life treatment of schizophrenia? Results of the Cohort for the General study of Schizophrenia (CGS). Schizophr Res. 2012;134(2–3):187–94.PubMedCrossRefGoogle Scholar
  19. 19.
    Leucht C, Heres S, Kane JM, et al. Oral versus depot antipsychotic drugs for schizophrenia—a critical systematic review and meta-analysis of randomised long-term trials. Schizophr Res. 2011;127(1–3):83–92.PubMedCrossRefGoogle Scholar
  20. 20.
    Olivares JM, Rodriguez-Morales A, Diels J, et al. Long-term outcomes in patients with schizophrenia treated with risperidone long-acting injection or oral antipsychotics in Spain: results from the electronic Schizophrenia Treatment Adherence Registry (e-STAR). Eur Psychiatry. 2009;24(5):287–96.PubMedCrossRefGoogle Scholar
  21. 21.
    Olivares JM, Rodriguez-Martinez A, Burón JA, et al. Cost-effectiveness analysis of switching antipsychotic medication to longacting injectable risperidone in patients with schizophrenia: a 12- and 24-month follow-up from the e-STAR database in Spain. Appl Health Econ Health Policy. 2008;6(1):41–53.PubMedCrossRefGoogle Scholar
  22. 22.
    Gaebel W, Schreiner A, Bergmans P, et al. Relapse prevention in schizophrenia and schizoaffective disorder with risperidone long-acting injectable vs quetiapine: results of a long-term, open-label. Randomized clinical trial. Neuropsychopharmacology. 2010;35(12):2367–77.PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Spill B, Konoppa S, Kissling W, et al. Long-term observation of patients successfully switched to risperidone long-acting injectable: a retrospective, naturalistic 18-month mirror-image study of hospitalization rates and therapy costs. Int J Psychiatry Clin Pract. 2010;14:53–62.CrossRefGoogle Scholar
  24. 24.
    Laux G, Heeg B, van Hout B, et al. Costs and effects or long-acting risperidone compared with oral atypical and conventional depot formulations in Germany. PharmacoEconomics. 2005;23(Suppl. 1):49–61.PubMedGoogle Scholar
  25. 25.
    Einarson T, Geitona M, Chaidemenos A, et al. Pharmacoeconomic analysis of paliperidone palmitate for treating schizophrenia in Greece. Ann Gen Psychiatry. 2012;11:18.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Einarson T, Vicente C, Zilbershtein R, et al. Pharmacoeconomic analysis of paliperidone palmitate versus olanzapine pamoate for chronic schizophrenia in Norway. Acta Neuropsychiatr. 2012. doi: 10.1111/j.1601-5215.2012.00670.x.Google Scholar
  27. 27.
    Mehnert A, Nicholl D, Pudas H, et al. Cost-effectiveness of paliperidone palmitate versus risperidone long-acting injectable and olanzapine pamoate for the treatment of patients with schizophrenia in Schweden. J Med Econ. 2012;15(5):844–61.PubMedCrossRefGoogle Scholar
  28. 28.
    Kim B, Lee TJ, Woo JM, et al. Cost-utility analysis of paliperidone Palmitat long acting injection (PLAI) vs oral atypical antipsychotics in non-adherent schizophrenia patients. Value Health. 2011;14(7):A294.CrossRefGoogle Scholar
  29. 29.
    Ahn J, McCombs JS, Jung C, et al. Classifying patients by antipsychotic adherence patterns using latent class analysis: characteristics of nonadherent groups in the California Medicaid (Medi-Cal) program. Value Health. 2008;11:48–56.PubMedCrossRefGoogle Scholar
  30. 30.
    Nasrallah HA. The case for long-acting antipsychotic agents in the post-CATIE era. Acta Psychiatr Scand. 2007;115:260–7.PubMedCrossRefGoogle Scholar
  31. 31.
    Sim K, Su A, Ungvari GS, et al. Depot antipsychotic use in schizophrenia: an East Asian perspective. Hum Psychopharmacol. 2004;19:103–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Edwards NC, Muser E, Doshi D, et al. The threshold rate of oral atypical anti-psychotic adherence at which paliperidone Palmitat is cost saving. J Med Econ. 2012;15(4):1–12.CrossRefGoogle Scholar
  33. 33.
    Briggs A, Wild D, Lees M, et al. Impact of schizophrenia and schizophrenia treatment-related adverse events on quality of life: direct utility elicitation. Health Qual Life Outcomes. 2008;6:105.PubMedCentralPubMedCrossRefGoogle Scholar
  34. 34.
    Lauer-Fischer GmbH. Lauer-Taxe [online]. http://taxe.lauer-fischer.de/Taxe/taxe.aspx (Accessed 4 Dec 2012).
  35. 35.
    Prenzler A, Zeidler J, Braun S, et al. Bewertung von Ressourcen im Gesundheitswesen aus der Perspektive der deutschen Sozialversicherung (Assessment of health care resources from the viewpoint of the German social insurance system). PharmacoEconomics. 2010;8(1):47–66.Google Scholar
  36. 36.
    Braun S, Prenzler A, Mittendorf T, et al. Bewertung von Ressourcenverbräuchen im deutschen Gesundheitswesen aus Sicht der Gesetzlichen Krankenversicherung (Appraisal of resource use in the German health-care system from the perspective of the statutory health insurance). Gesundheitswesen. 2009;71:19–23.PubMedCrossRefGoogle Scholar
  37. 37.
    Kassenärztliche Bundesvereinigung. Adressliste der Kassenärztlichen Vereinigungen (Adress list of the Associations of Statutory Health Insurance Physicians) [online]. http://www.kbv.de/wir_ueber_uns/4130.html#Kassen%C3%A4rztliche%20Vereinigung%20Baden-W%C3%BCrttemberg (Accessed 4 Dec 2012).
  38. 38.
    Statistisches Bundesamt. Bevölkerung nach Bundesländern (Population in federal states) [online]. https://www-genesis.destatis.de/genesis/online/link/tabelleErgebnis/12411-0021.
  39. 39.
    Schneider F, Falkai P, Maier W. Psychiatrie 2020 plus (Psychiatry 2020 plus) [online]. http://www.springerlink.com/content/n14116/#section=1081192&page=1 (Accessed 4 Dec 2012).
  40. 40.
    Braun S, Zeidler J, Mittendorf T, et al. Kosteneffektivität von Quetiapin und Haloperidol bei Patienten mit partiell therapieresistenter Schizophrenie (Cost-effectiveness analysis of quetiapine and haloperidol for partial responders in schizophrenia). PharmacoEconomics. 2010;8(1):21–9.Google Scholar
  41. 41.
    Statistisches Bundesamt. Verbraucherpreisindex (Consumer price index) [online]. https://www-genesis.destatis.de.
  42. 42.
    Kassenärztliche Vereinigung Westfalen-Lippe. Heilmittel-Einzelpreise (remedy price list) [online]. http://www.kvwl.de/arzt/verordnung/hhm/heilmittel/preise.htm (Accessed 4 Dec 2012).
  43. 43.
  44. 44.
    Bestehorn M, Tischer B, Glaser P, et al. Repräsentative Studie zur Verteilung schizophrener Patienten auf medizinische Versorgungseinrichtungen in Deutschland (Representative Study on the Distribution of Schizophrenia Patients to Medical Health Care Institutions in Germany). Fortschr Neurol Psychiatr Grenzgeb. 1999;67:487–92.CrossRefGoogle Scholar
  45. 45.
    Fritze J. Entgeltsystem für psychiatrische und psychosomatische Einrichtungen (Remuneration System for psychiatric and psychosomatic facilities). In: Klauber J, Geraedts M, Friedrich J, editors. Krankenhaus-Report 2010. Stuttgart: Schattauer; 2009. p. 181–208.Google Scholar
  46. 46.
    Statistisches Bundesamt. Diagnosedaten der Krankenhäuser (Diagnostic data of the hospitals) [online]. http://www.gbe-bund.de (Accessed 4 Dec 2012).
  47. 47.
    Hong J, Windmeijer F, Novick D, et al. The cost of relapse in patients with schizophrenia in the European SOHO (Schizophrenia Outpatient Health Outcomes) study. Progr Neuropsychopharmacol Biol Psychiatry. 2009;33(5):835–41.CrossRefGoogle Scholar
  48. 48.
    Lieberman JA, Koreen AR, Chakos M, et al. Factors influencing treatment response and outcome of first-episode schizophrenia: implications for understanding the pathophysiology of schizophrenia. J Clin Psychiatry. 1996;57(Suppl 9):5–9.PubMedGoogle Scholar
  49. 49.
    Schützwohl M, Glöckner M, Matthes C, et al. The burden on relatives of acute mentally ill within the first four weeks of day hospital and inpatient treatment. Results from a randomized controlled trial. Psychiatr Prax. 2005;32(6):281–8.PubMedCrossRefGoogle Scholar
  50. 50.
    Schmid R, Neuner T, Cording C, et al. Schizophrenic patients’ quality of life-association with coping, locus of control, subjective well-being, satisfaction and patient-judged caregiver burden. Psychiatr Prax. 2006;33(7):337–43.PubMedCrossRefGoogle Scholar
  51. 51.
    Emsley R, Nuamah I, Hough D, et al. Treatment response after relapse in a placebo-controlled maintenance trial in schizophrenia. Schizophr Res. 2012;138(1):29–34.PubMedCrossRefGoogle Scholar
  52. 52.
    Heres S, Schmitz FS, Leucht S, et al. The attitude of patients towards antipsychotic depot treatment. Int Clin Psychopharmacol. 2007;22(5):275–82.PubMedCrossRefGoogle Scholar
  53. 53.
    Patel MX, de Zoysa N, Bernadt M, et al. Are depot antipsychotics more coercive than tablets? The patient’s perspective. J Psychopharmacol. 2010;24(10):1483–9.PubMedCrossRefGoogle Scholar
  54. 54.
    Patel MX, De Zoysa N, Bernadt M, et al. Depot and oral antipsychotics: patient preferences and attitudes are not the same thing. J Psychopharmacol. 2009;23(7):789–96.PubMedCrossRefGoogle Scholar
  55. 55.
    Frey S, Linder R, Juckel G, et al. Cost-effectiveness of long-acting injectable risperidone versus flupentixol decanoate in the treatment of schizophrenia: a Markov model parameterized using administrative data. Eur J Health Econ. 2013. doi: 10.1007/s10198-013-0460-9.PubMedGoogle Scholar
  56. 56.
    Stargardt T, Edel MA, Ebert A, et al. Effectiveness and cost of atypical versus typical antipsychotic treatment in a nationwide cohort of patients with schizophrenia in Germany. J Clin Psychopharmacol. 2012;32(5):602–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  • Jan Zeidler
    • 1
    Email author
  • Jörg Mahlich
    • 2
    • 3
  • Wolfgang Greiner
    • 4
  • Stephan Heres
    • 5
  1. 1.Center for Health Economics Research Hannover (CHERH)Leibniz University HannoverHannoverGermany
  2. 2.Health Economics, Janssen-Cilag GmbHNeussGermany
  3. 3.Economics DepartmentUniversity of ViennaViennaAustria
  4. 4.Department of Health Economics and Health Care ManagementUniversity of BielefeldBielefeldGermany
  5. 5.Klinik für Psychiatrie und PsychotherapieTechnische Universität MünchenMunichGermany

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