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



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.


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.


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.


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.


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.


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.



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.


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)


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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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