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PharmacoEconomics

, Volume 23, Supplement 1, pp 35–47 | Cite as

Long-acting risperidone compared with oral olanzapine and haloperidol depot in schizophrenia: a Belgian cost-effectiveness analysis

  • Diana De Graeve
  • Ann Smet
  • Angelika Mehnert
  • Sue Caleo
  • Houda Miadi-Fargier
  • Guillermo Jasso Mosqueda
  • Damien Lecompte
  • Joseph Peuskens
Original Research Article

Abstract

Patients with schizophrenia suffer numerous relapses and rehospitalizations that are associated with high direct and indirect medical expense. Suboptimal therapeutic efficacy and, in particular, problems with compliance are major factors leading to relapse. Atypical antipsychotic agents offer improved efficacy and a lower rate of extrapyramidal adverse effects compared with conventional antipsychotic drugs. Long-acting intramuscular risperidone combines these benefits with improvements in compliance associated with depot injections. To assist decision making regarding the place of long-acting risperidone in therapy, a cost-effectiveness analysis of strategies involving first-line treatment with long-acting risperidone, oral olanzapine or depot haloperidol was performed from the perspective of the Belgian healthcare system. A decision tree model was created to compare the cost effectiveness of three first-line treatment strategies in a sample of young schizophrenic patients who had been treated for 1 year and whose disease had not been diagnosed for longer than 5 years. The model used a time horizon of 2 years, with health state transition probabilities, resource use and cost estimates derived from clinical trials, expert opinion and published prices. The four health states in the model were derived from an analysis of the literature. The principal efficacy measure was the proportion of patients successfully treated, defined as those who responded to initial treatment and who had none to two episodes of clinical deterioration without needing a change of treatment over the 2-year period. Comprehensive sensitivity analysis was carried out to test the robustness of the model. A greater proportion of patients were successfully treated with long-acting risperidone (82.7%) for 2 years, compared with those treated with olanzapine (74.8%) or haloperidol (57.3%). Total mean costs per patient over 2 years were €16 406 with long-acting risperidone, €17 074 with olanzapine and €21 779 with haloperidol (year of costing 2003). The mean cost-effectiveness ratios were €19 839, €22 826 and €38 008 per successfully treated patient for long-acting risperidone, olanzapine and haloperidol, respectively. Results of the sensitivity analysis confirmed that the results were robust to a wide variation of different input variables (effectiveness, dosing distribution, patient status according to healthcare system). Long-acting risperidone was the dominant strategy, being both more effective and less costly than either oral olanzapine or depot haloperidol. Long-acting risperidone appears to represent a favourable firstline strategy for patients with schizophrenia requiring long-term maintenance treatment.

Keywords

Schizophrenia Haloperidol Risperidone Olanzapine Antipsychotic Agent 
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

Acknowledgements

The authors would like to thank the following persons who contributed to the Delphi panel: Drs Marc De Hert, André De Nayer, Vincent Dubois, Michel Floris, Benoit Gillain, Joseph Hulselmans, Laurent Mallet, Claudine Mertens, Frans Vandendriessche.

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Copyright information

© Adis Data Information BV 2005

Authors and Affiliations

  • Diana De Graeve
    • 1
  • Ann Smet
    • 2
  • Angelika Mehnert
    • 3
  • Sue Caleo
    • 4
  • Houda Miadi-Fargier
    • 5
  • Guillermo Jasso Mosqueda
    • 5
  • Damien Lecompte
    • 6
  • Joseph Peuskens
    • 7
  1. 1.Faculty of Applied EconomicsUniversity of AntwerpAntwerpenBelgium
  2. 2.Janssen-Cilag NVBerchem, AntwerpBelgium
  3. 3.Janssen-Cilag GmbHNeussGermany
  4. 4.Janssen Pharmaceutica NVBeerseBelgium
  5. 5.AREMIS ConsultantsNeuilly-sur-SeineFrance
  6. 6.Psychiatric Service of University Hospital BrugmannBrusselsBelgium
  7. 7.University Centre St Jozef, Kortenberg, Katholieke Universiteit LeuvenLeuvenBelgium

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