Skip to main content
SpringerLink
Log in

Pharmacoeconomics of long-acting risperidone: Results and validity of cost-effectiveness models

  • Review Article
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Abstract

Relapse is the primary cost driver in schizophrenia and is closely related to levels of adherence (compliance) with therapy. Both atypical antipsychotic agents and depot preparations have been shown to be useful in improving therapeutic adherence compared with oral conventional antipsychotic agents. Long-acting risperidone is a new formulation of an atypical antipsychotic agent that combines the pharmacological advantages of the atypical drugs with those of itsmode of administration. The likelihood of improved compliance compared with existing treatment regimens implies that the higher acquisition costs would be offset by reduced rates of relapse. Economic models, which represent the health and economic outcomes of patients or populations under a variety of scenarios, are used to evaluate the economic implications of schizophrenia treatment. These models need to reflect clinical reality while simultaneously remaining as simple as possible. The assumptions and results need to be made transparent; data quality must be described explicitly; areas of uncertainty must be comprehensively explored through sensitivity analysis; and individual models must be validated, for example by comparing them with others in the therapeutic area. In this article, costeffectiveness models of long-acting risperidone developed for different countries are discussed in terms of design, data sources and robustness, and the implications of the results for the treatment of schizophrenia are also reviewed.A discrete event simulation (DES) model that was developed using UK cost and treatment assumptions, in order to provide a ‘proof of concept’, is described.Country-specific models for the United States, Canada, Germany, the Netherlands, France, Belgium, Italy and Portugal, using either DES or decision analytical structures, are then discussed. Comprehensive sensitivity analyses were conducted to assess the robustness of the results. In each case, long-acting risperidone produced additional clinical benefit and cost savings compared with other treatment strategies, despite significant variations in cost effectiveness and therapeutic approaches. In particular, improved adherence arising through the use of long-acting risperidone provides a cost-effective strategy for treating patients with schizophrenia, irrespective of the country analysed.The information generated in this analysis therefore provides one potentialmethod for improving resource allocation and reducing the health burden related to schizophrenia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
PANSS
Table II
Table III
Table IV

Similar content being viewed by others

References

  1. Cooper JE. Schizophrenia and allied condition. Med Int 1991; 94: 3917–22

    Google Scholar 

  2. Davies L, Drummond M. The economic burden of schizophrenia. Psychiatr Bull 1990; 14: 522–5

    Article  Google Scholar 

  3. McGrath J, Saha S, Welham J, et al. A systematic review of the incidence of schizophrenia: the distribution of rates and the influence of sex, urbanicity, migrant status and methodology. BMC Medicine 2004; 2 [online]. Available from URL: http://www.biomedcentral.com/1741-7015/1742/1713 [Accessed March 2005]

    Google Scholar 

  4. American Psychiatric Association. Practice guideline for the treatment of patients with schizophrenia. American Psychiatric Association. Am J Psychiatry 1997; 154 (Suppl.): 1-63

    Google Scholar 

  5. National Institute for Clinical Excellence. Guidance on the use of newer (atypical) antipsychotic drugs for the prevention of relapse in patients with schizophrenia 2002 [online]. Available from URL: http://www.nice.orh.uk/ pdf/ [Accessed March 2004]

  6. Lehman AF, Steinwachs DM. Translating research into practice: the Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations. Schizophr Bull 1998; 24: 1–10

    Article  PubMed  CAS  Google Scholar 

  7. Chue P, Devos E, Duchesne I, et al. Hospitalisation rates in patients during long-term treatment with long-acting risperidone injection. Int J Clin Neuropsychopharmacol 2002; 5(Suppl. 1) S128–9. Abstract no. P.4.E. 041

    Google Scholar 

  8. Fleischhacker WW, Eerdekens M, Karcher K, et al. Treatment of schizophrenia with long-acting injectable risperidone: a 12-month open-label trial of the first long-acting second-generation antipsychotic. J Clin Psychiatry 2003; 64: 1250–7

    Article  PubMed  CAS  Google Scholar 

  9. Harrison TS, Goa KL. Long-acting risperidone: a review of its use in schizophrenia. CNS Drugs 2004; 18: 113–32

    Article  PubMed  CAS  Google Scholar 

  10. Kane JM, Eerdekens M, Lindenmayer JP, et al. Long-acting injectable risperidone: efficacy and safety of the first long-acting atypical antipsychotic. Am J Psychiatry 2003; 160: 1125–32

    Article  PubMed  Google Scholar 

  11. Lasser RA, Bossie CA, Gharabawi GM, et al. Patients with schizophrenia previously stabilized on conventional depot antipsychotics experience significant clinical improvements following treatment with long-acting risperidone. Eur Psychiatry 2004; 19: 219–25

    Article  PubMed  Google Scholar 

  12. Buxton MJ, Drummond MF, van Hout BA, et al. Modelling in economic evaluation: an unavoidable fact of life. Health Economics 1997; 6: 217–27

    Article  PubMed  CAS  Google Scholar 

  13. Weinstein MC, O’Brien B, Hornberger J, et al. Principles of good practice of decision analytic modeling in health care evaluation: report of an ISPOR Task Force on Good Research Practices Modeling Studies. Value Health 2003; 6: 9–17

    Article  PubMed  Google Scholar 

  14. Andreasen NC. Assessment issues and the cost of schizophrenia. Schizophr Bull 1991; 17: 475–81

    Article  PubMed  CAS  Google Scholar 

  15. Glazer WM, Johnstone BM. Pharmacoeconomic evaluation of antipsychotic therapy for schizophrenia. J Clin Psychiatry 1997; 58 (Suppl. 10): 50–4

    PubMed  Google Scholar 

  16. Terkelsen KG, Menikoff A. Measuring the costs of schizophrenia. Implications for the post-institutional era in the US. PharmacoEconomics 1995; 8: 199–222

    Article  PubMed  CAS  Google Scholar 

  17. Foster RH, Goa KL. Risperidone. A pharmacoeconomic review of its use in schizophrenia. PharmacoEconomics 1998; 14: 97–133

    Article  PubMed  CAS  Google Scholar 

  18. Knapp M, Chisholm D, Leese M, et al. Comparing patterns and costs of schizophrenia care in five European countries: the EPSILON study. European Psychiatric Services: Inputs Linked to Outcome Domains and Needs. Acta Psychiatr Scand 2002; 105: 42–54

    Article  PubMed  Google Scholar 

  19. Knapp M, Mangalore R, Simon J. The global costs of schizophrenia. Schizophr Bull 2004; 30: 279–93

    Article  PubMed  Google Scholar 

  20. Knapp M. Costs of schizophrenia. Br J Psychiatry 1997; 171: 509–18

    Article  PubMed  CAS  Google Scholar 

  21. Wyatt RJ, Henter I, Leary MC, et al. An economic evaluation of schizophrenia — 1991. Soc Psychiatry Psychiatr Epidemiol 1995; 30: 196–205

    PubMed  CAS  Google Scholar 

  22. Davies LM, Drummond MF. Economics and schizophrenia: the real cost. Br J Psychiatry 1994; 165 (Suppl. 25): 18–21

    Google Scholar 

  23. Rice DP, Miller LS. Health economics and cost implications of anxiety and other mental disorders in the United States. Br J Psychiatry Suppl 1998; 34: 4–9

    PubMed  Google Scholar 

  24. Almond S, Knapp M, Francois C, et al. Relapse in schizophrenia: costs, clinical outcomes and quality of life. Br J Psychiatry 2004; 184: 346–51

    Article  PubMed  Google Scholar 

  25. Carr V, Hocking B, Jablensky A, et al. Schizophrenia: costs. An analysis of the burden of schizophrenia and related suicide in Australia. An Access Economics Report for SANE Australia, 2002

    Google Scholar 

  26. Weiden P, Glazer W. Assessment and treatment selection for “revolving door” inpatients with schizophrenia. Psychiatr Q 1997; 68: 377–92

    Article  PubMed  CAS  Google Scholar 

  27. National Institute for Clinical Excellence. Schizophrenia: core interventions in the treatment and management of schizophrenia in primary and secondary care. London, NICE, 2003

  28. Schizophrenia Platform. Divided attention, shared care: from problem areas to quality in the care of patients with schizophrenia. Schizophrenia Platform the Netherlands. 2000. Available at: http://www.schizofrenie-platform.nl/ documents/Schizophrenia_Platform_NL_report_English_ version.htm [Accessed 4 April 2005]

  29. Briggs AH. Handling uncertainty in cost-effectiveness models. PharmacoEconomics 2000; 17: 479–500

    Article  PubMed  CAS  Google Scholar 

  30. Edwards NC, Locklear JC, Rupnow MFT, et al. Cost effectiveness of long-acting risperidone injection versus alternative antipsychotic agents in patients with schizophrenia in the USA. PharmacoEconomics 2005; 23 (Suppl.1): 75–89

    Google Scholar 

  31. Chue PS, Heeg BMS, Buskens E, et al. Modelling the impact of compliance on the costs and effects of longacting risperidone in Canada. PharmacoEconomics 2005; 23 (Suppl. 1): 62–74

    PubMed  Google Scholar 

  32. Laux G, Heeg BMS, van Hout BA, et al. Costs and effects of long-acting risperidone compared with oral atypical and conventional depot formulations in Germany. PharmacoEconomics 2005; 23 (Suppl. 1): 49–61

    PubMed  CAS  Google Scholar 

  33. Heeg BM, van Aalst G, van den Arend IJ, et al. A discrete events model of long-term outcomes and cost of treatment with long acting risperidone in schizophrenia. Value Health 2003; 6: 515. Abstract PMH 5

    Article  Google Scholar 

  34. Llorca PM, Miadi-Fargier H, Lançon C, et al. Costeffectiveness analysis of schizophrenic patient care strategies: impact of an atypical antipsychotic in a long-acting injection formulation [in French]. L’Encephale 2005; 31: 235–46

    Article  PubMed  CAS  Google Scholar 

  35. De Graeve D, Smet A, Mehnert A, et al. Long-acting risperidone compared with oral olanzapine and haloperidol depot in schizophrenia: a Belgian cost-effectiveness analysis. PharmacoEconomics 2005; 23 (Suppl. 1): 35–47

    PubMed  Google Scholar 

  36. Crowley S, Schrower R, Neville AM. Cost-effectiveness analysis in the Australian setting of risperidone longacting injection for the treatment of patients with schizophrenia who are partially adherent to their medication. Value Health 2004; 7: 781–2. Abstract PMH 30

    Article  Google Scholar 

  37. Davies A, Schrover R, Crowley S, et al. Economic analysis of risperidone long-acting injection in New Zealand. Value Health 2004; 7: 779. Abstract PMH 10

    Article  Google Scholar 

  38. Heeg BM, Buskens E, Vaz Serra A, et al. Costs and effects of Risperdal Consta (TM) in comparison to conventional depot and short-acting atypical formulations in Portugal [Abstract]. Proceedings of the 7th Annual European Congress; 2004 Oct 24-26; Hamburg, Germany

    Google Scholar 

  39. Mantovani LG, Berto P, D’Ausilio A, et al. Costs andeffects of long-acting risperidone (LAR) versus atypical antipsychotics in the treatment of schizophrenic patients in Italy. Farmeconomica e Percosi Terapeutica 2004; 5: 5–11

    Google Scholar 

  40. Briggs A, Schulper M. An introduction to Markov modelling for economic evaluation. PharmacoEconomics 1998; 13: 397–409

    Article  PubMed  CAS  Google Scholar 

  41. Heeg BMS, Buskens E, Knapp M, et al. Modelling the treated course of schizophrenia: development of a discrete event simulation model. PharmacoEconomics 2005; 23 (Suppl. 1): 17–33

    PubMed  Google Scholar 

  42. Glazer WM, Ereshefsky L. A pharmacoeconomic model of outpatient antipsychotic therapy in “revolving door” schizophrenic patients. J Clin Psychiatry 1996; 57: 337–345

    PubMed  CAS  Google Scholar 

  43. Love RC, Kelly DL, Moore DB, et al. A comparison of rehospitalization rates between patients treated with atypical antipsychotics and those treated with deépôt antipsychotics. Proceedings of the 37th Annual Meeting of the American College of Neuropsychopharmacology; 1998 Dec 14-18; Las Croabas, Puerto Rico

    Google Scholar 

  44. Rabinowitz J, Lichtenberg P, Kaplan Z, et al. Rehospitalization rates of chronically ill schizophrenic patients discharged on a regimen of risperidone, olanzapine, or conventional antipsychotics. Am J Psychiatry 2001; 158: 266–9

    Article  PubMed  CAS  Google Scholar 

  45. Hay J, Jackson J. Methodological issues in conducting pharmacoeconomic evaluations: modeling structures. Value in Health 1999; 2: 78–81

    Article  PubMed  CAS  Google Scholar 

  46. McEvoy JP, Scheifler PL, Frances A. Treatment of schizophrenia 1999. The expert consensus guideline series. J Clin Psychiatry 1999; 60 (Suppl. 11): 3–80

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pharmacology, University of Liverpool, Liverpool, UK

    Alan Haycox

Authors
  1. Alan Haycox
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alan Haycox.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Haycox, A. Pharmacoeconomics of long-acting risperidone: Results and validity of cost-effectiveness models. Pharmacoeconomics 23 (Suppl 1), 3–16 (2005). https://doi.org/10.2165/00019053-200523001-00002

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00019053-200523001-00002

Keywords

Search

Navigation