Cost-effectiveness analysis of switching antipsychotic medication to long-acting injectable risperidone in patients with schizophrenia
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The availability of long-acting injectable risperidone may increase adherence to antipsychotic treatment and lead to improved clinical and economic outcomes for patients with schizophrenia.
To investigate the cost effectiveness of treatment with long-acting injectable risperidone compared with previous antipsychotic regimens in patients with schizophrenia enrolled in the electronic Schizophrenia Treatment Adherence Registry (e-STAR) in Spain.
e-STAR is an international, long-term, ongoing, observational study of schizophrenia patients who, during their routine course of clinical practice, are started on a new antipsychotic treatment.
In e-STAR, data are collected at baseline, retrospectively over a minimum period of 12 months and up to a maximum of 24 months, and prospectively at 3-month intervals for 24 months after the start of a new antipsychotic drug. For the purpose of this study, patients who started treatment with long-acting injectable risperidone during their routine clinical management and were enrolled in the e-STAR study in Spain were eligible. The effectiveness of long-acting injectable risperidone compared with previous antipsychotic treatment, defined as the absence of hospitalizations or relapses, was assessed at 12 and 24 months of treatment. Acquisition costs of antipsychotic drug therapy were based on the official registered price. Drug prices from source were in €, year 2005 values; hospital costs from source were in €, year 2001 values, and were inflated to reflect 2005 costs. Complete follow-up data were available for 788 patients at 12 months after starting long-acting injectable risperidone and for 757 patients at 24 months.
In terms of effectiveness, at 12 months after switching to long-acting injectable risperidone, there was a higher percentage of patients who did not require hospitalization (89.1%), did not relapse (85.4%) or neither required hospitalization nor relapsed (82.4%) as compared retrospectively with the same period for the previous treatment (67%, 47.8% and 59.8%, respectively). The corresponding figures at 24 months also favoured treatment with long-acting injectable risperidone (85.2% vs 60%, 88.5% vs 47.4% and 77% vs 53.6%, respectively). Treatment with long-acting injectable risperidone was associated with higher medication costs per month compared with previous antipsychotic medication after 12 (€405.80 vs €128.16) and 24 months (€407.33 vs €142.77) of follow-up. Cost effectiveness per month per patient was lower for risperidone than previous antipsychotic medication in the three patient scenarios: without hospitalization (€539.82 vs €982.13), without relapse (€519.67 vs €1242.03) and without hospitalization and without relapse (€597.22 vs €1059.39).
Treatment with long-acting injectable risperidone compared with previous antipsychotic medications resulted in a higher number of patients not requiring hospitalization, not relapsing, and not requiring hospitalization and not showing relapse, resulting in risperidone being more cost effective per month per patient.
It is important to note that real-world variations in adherence would automatically be controlled from within a randomized control trial, and hence, any evaluation of variations in adherence inevitably requires a real-world focus. On the basis of these findings, which were obtained in real-world clinical practice, long-acting injectable risperidone is predicted to be the dominant strategy because it results in effective symptom control and direct medical cost savings. However, because of limitations in methodology, any conclusions should, at this stage, be treated as tentative, and confirmation in more detailed follow-up studies is required. Cost-effectiveness comparisons based on experimental evaluations of relapse minimization strategies are also required. In order to avoid estimation biases in the future, a prospectively designed study is needed.
KeywordsSchizophrenia Risperidone Antipsychotic Medication Antipsychotic Treatment Psychotic Episode
The authors gratefully acknowledge the unrestricted sponsorship funding provided by Janssen-Cilag. José M. Olivares is member of national and international advisory boards for Janssen-Cilag, Lilly and Astra Zeneca, has been involved in designing and participating in clinical trials for Janssen-Cilag, Lilly, Astra Zeneca, Lundbeck and Bristol-Myers, and has received educational grants for research, honoraria and travel support for activities as a consultant/advisor and lecturer/faculty member for Janssen-Cilag, Lilly, Astra Zeneca, Lundbeck, Bristol-Myers and Glaxo-Smith-Klein.
Alfonso Rodriguez-Martinez has received honoraria as a consultant/advisor for Janssen-Cilag, Pfizer, Astra Zeneca, Aventis and Bristol-Myers.
Jose A. Burón is the Medical Director of the Medical Department of Janssen-Cilag and owns stock in Johnson & Johnson.
David Alonso-Escolano is the Medical Affairs Manager of Psychiatry of the Medical Department of Janssen-Cilag and owns stock in Johnson & Johnson.
Alexander Rodriguez-Morales is the Group Medical Affairs Manager of Psychiatry for the Medical Department of Janssen-Cilag and owns stock in Johnson & Johnson.
We thank Marta Pulido, MD, for editing the manuscript and for editorial assistance.
e-STAR Spanish Study Group: J.C. Villalobos Vega, J. Alonso Cuéllar, F.J. Alberca de Castro, C. Morillo-Velarde Quintero, J. F. Román Martíin, P. Tabares Domínguez, J.L. Prados Ojeda, S. Sanz Cortés, F.I. Mata Cala, C. Gutiérrez Marín, L. Moyano Castro, M.A. Haza Duaso, J. Requena Albarracín, G. Narbona Vergara, J.A. Fernández Benítez, F. Mayoral Cleries, J.M. García-Herrera Pérez-Brian, A. Bordallo Aragón, J.C. Rodríguez Navarro, J.A. Algarra Biedma, R. Bravo de Pedro, J.F. Delgado González, M.E. Jaén López, H. Díaz Moreno, J.A. Soto López, E. Ojeda Rodríguez, C. Martínez de Hoyos, M. Pardilla Sacristán, M.D. Molina Martín, E. Martín Ballesteros, P.A. Sopelana Rodríguez, L. Fernández Menéndez, R. Santos Rivas, P. del Pino Cuadrado, J. Correas Lauffer, J.J. Rodríguez Solano, J.M. Fernández Martínez, F. García Solano, P. García-Lamberde Rodríguez, J.A. Romero Rodríguez, T. Rodríguez Cano, M. Ducaju Fortacin, J.M. Blanco Lobeiras, J.M. Piñeiro Sampedro, A. Pérez Bravo, A. Fernández Pellicer, M.D. Alonso López, J. Fraga Liste, M. Riobo Fernández, A. Casas Losada, R. Vazquez-Noguerol Mendez, S. Agra Romero, J.J. Blanco Blanco, I. Tortajada Bonaselt, M.C. García Mahia, E. Ferrer Gómez del Valle, P. Quiroga Yañez, M. Gelabert Camarasa, J.A. Barbado Alonso, G. Florez Mendez, F. Doce Feliz, M.A. López Lamela, M. Vega Piñero, P. Fuentes Alvarado, I. López Gómez, P. Fadon Martín, J.L. Santos Gómez, A. García López, R. Rodríguez Jiménez, A. Escudero Nafs, N. Casas Barquero, R. Fernández-Villamor Ortiz, J.L. Velez Noguera, P. Ruiz Carrasco, J. Martín Muñoz, M. Masegoza Palma, C. Marín Hortelano, L. Sánchez Bonome, J. Sánchez Sevilla, J.M. Mongil San Juan, J.M. García Ramos, J.L. Vallejo Muñoz, J. Elorza Guisasola, L. Santamaria Vazquez, F. Campo Guerras, F.J. Arrufat Nebot, F.J. Baron Fernández, A.L. Palomo Nicolau, R. Catala Subirats, M. Messays Kidias, V. Fabregat Navarro, B. Frades García, F. Mejias del Rosal, T. de Vicente Muñoz, J. Año Ballester, P. Malabia Lieb, A. Delgado Martel, E. Roca Bea, I. Grau Joaquim, F. Boatas Enjuanes, M. Bañuelos Piñol, E. Fontova i Carbonell, R. Martín Muñoz, C. Argila Giribets, L. Albages Sans, A. Serrano Blanco, M. Arcega Felipe, P. González Muñoz, A. Pons Villanueva, M. Bernardo Arroyo, R. Coronas Borri, S. Miret Fallada, M. Celma Merola, E. Parellada Rodon, J.R. Pigem Palmes, E. Pérez Martínez, J. Matarredona Catala, A. Sandoval Coca, F. Pascual Ferrandiz, E. Ferrandiz Paya, G. Iturri Caballero, A. Franco Bonet, J. Fluvia Figueras, P. Moreno Pagador, M. Medina Garibo, V. Pérez Camo, C. Sanz Carrillo, C. Pelegrin Valero, F.J. Caro Rebollo, J. García Campayo, J.M. Sala Ayma, M. Martínez Roig, M.A. de Uña Mateos, R. García Bertolin, A. Martín García, F. Jiménez Mazo, J.L. Galvez Velasco, L. Santa Maria Pérez, C. Jiménez Casado, J.J. Mancheño Barba, M. Conde Diaz, J.P. Alcon Rubio, A. Soler Mandoli, A. Uson Herrero, A. Rodríguez Martínez, P. Salgado Serrano, E. Nieto Rodríguez, J. 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Liñana Martorell, A. Clar Forteza, E. Rodríguez Arrebola, M. Rodríguez de la Torre, C.G. Anton Saiz, C. Bardolet i Casas, E. Rodríguez Linde, R. De Arce Cordon, E.M. Padial Molina, F.J. Ruiz Carazo, J.J. Muro Romero, D. Vico Cano, M. Soria Dorado, S. Campos Velazquez, A.J. Rodríguez Sánchez, S. Ocio Leon, H. Pachas Sánchez, M. Henry Benitez, A. Intxausti Zugarramurai, M.A. Contreras, M. De la Varga González, P. Barreiro Marín, F. Gómez Robina, M. Sánchez García, F.J. Otero Pérez, P. Cubero Bros, A. Carrillo Gómez, J. de Dios Molina Martín, J.L. Carrasco Perera, M. C. Averbach, J.L. Carrasco Perera, E. Goenaga Palancares, M.T. Gallego de Dios, C. Fernández Rojo, S. Sánchez Iglesias, M.I. Rubio Merino, N. Prieto Mestre, A. Pérez Urdaniz, J.M. Martínez Sánchez, R. Gordo Seco, J. Franco Muñoz, M. Mateos Agut, M.L. Blanco Lozano, F. Martín Herguedas, A. Torcal Pena, J. Vicente García, A. Varona Martínez, O. Sanz Granado, M.A. Medina Fernández, J.M. Moran Canseco, P.A. 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