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The European Journal of Health Economics

, Volume 15, Issue 2, pp 133–142 | Cite as

Cost-effectiveness of long-acting injectable risperidone versus flupentixol decanoate in the treatment of schizophrenia: a Markov model parameterized using administrative data

  • Simon FreyEmail author
  • Roland Linder
  • Georg Juckel
  • Tom Stargardt
Original Paper

Abstract

We use longitudinal patient-level data from a German sickness fund with 7.26 million insured in a Markov-simulation model to assess the cost-effectiveness of long-acting injectable risperidone (LAI-RIS) compared with long-acting injectable flupentixol (LAI-FLX) in the long-term management of schizophrenia. We simulate treatment costs from the payer’s perspective, hospitalization, the probability to be prescribed co-medication, and treatment discontinuation over a 2-year time horizon. Model inputs were derived from 935 patients hospitalized with schizophrenia between 2005 and 2008 who received either LAI-RIS or LAI-FLX for at least 1 month. After 2 years, 89.4 % (95.8 %) of patients who were initiated on LAI-RIS (LAI-FLX) discontinued the initial regimen. The number of days spent in hospital per month and patient was slightly lower with LAI-RIS (1.08 vs. 1.28 days, p < 0.001). The proportion of patients receiving side-effect co-medication was lower with LAI-RIS (8.3 vs. 15.0 % per month, p < 0.001). Mean total costs of treatment per patient and month were 1,015 € under LAI-RIS and 395 € under LAI-FLX, resulting in an ICER of 3,088 € (95 % CI [−913 €; 3,551 €]) for an avoided hospital day per patient and month in the base case scenario with a 15.1 % probability of LAI-FLX being the dominant treatment strategy. Cost differences were mainly attributable to the higher drug costs of LAI-RIS. The effectiveness of LAI-RIS in preventing hospital days appears to be similar to LAI-FLX, with a slight superiority in side-effect and switching rates. This comes at the cost of substantially higher treatment expenses. From a decision-maker’s point of view, the use of health insurance data as a source of input for decision models appears to be a reasonable alternative to models driven by clinical data only.

Keywords

Schizophrenia Long-acting injectable risperidone Flupentixol decanoate Markov model Cost-effectiveness Administrative data 

JEL Classification

I11 I19 

Notes

Acknowledgments

This study was kindly supported by an investigator-initiated grant from Bayer Vital GmbH. GJ has received grants or payments for lectures from manufacturers of antipsychotics (Astra Zeneca, Bayer, Bristol Meyers Squib, Eli Lilly, Janssen Cilag, Pfizer). TS has received grants from manufacturers of antipsychotics (Bayer, Lundbeck). RL is a health insurance employee.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Simon Frey
    • 1
    Email author
  • Roland Linder
    • 2
  • Georg Juckel
    • 3
  • Tom Stargardt
    • 1
  1. 1.Hamburg Center for Health Economics (HCHE)University of HamburgHamburgGermany
  2. 2.Scientific Institute of TK for Benefit and Efficiency in Health Care (WINEG)HamburgGermany
  3. 3.Department of Psychiatry, Psychotherapy and Preventive MedicineRuhr University BochumBochumGermany

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