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Cost-utility analysis of long-acting paliperidone in comparison with oral risperidone, oral paliperidone and long-acting risperidone in the maintenance treatment of schizophrenia in the Czech Republic

Auhtors: Kolek M., Duba J., Veselá Š., Pasztor B., Dolečková J.
Objectives. Lifetime prevalence of schizophrenia ranges from 1 to 1.5%. The number of patients in the
Czech Republic amounts annually to approximately 126,000. Schizophrenia causes significant increases in
mortality, shortening life expectancy by 25 years compared to the general population. Patients on longacting
paliperidone treatment remain in remission longer and thus experience higher quality of life.
Methods. Cost-utility analysis was performed using a Markov model. The primary outcome was
ICER/QALY. Oral risperidone, oral paliperidone and long-acting risperidone were selected as comparators.
The basic components of the model include probabilities of relapse, individual hazard ratios for noncompliance
by medication type and switch of treatment probabilities. Specific utilities for each health state
were considered. Among relevant costs, reflecting payer's perspective, drug acquisition costs, monitoring
costs, costs of relapses, follow-up care and adverse events were considered.
Results. Long-acting paliperidone reached ICER of EUR 16,233/QALY compared to oral risperidone, EUR
15,058/QALY to oral paliperidone and EUR 335/QALY to long-acting risperidone. The robustness of the
model was supported by one-way deterministic analysis and probabilistic sensitivity analysis, which gave
stable results. Long-acting paliperidone was cost effective in 97% of the simulations compared to oral
risperidone. Long-acting paliperidone treatment gained incremental 0.903 QALYs on average compared
to oral risperidone.
Conclusions. The treatment of schizophrenia using long-acting paliperidone is associated with
increased QALYs. It reduces incidence of adverse events, results in better prevention of relapses
and can be considered as a cost-effective treatment in the Czech Republic.

Presented at the ISPOR 17th Annual European Congress, 8-12 November 2014 at the Amsterdam RAI in Amsterdam, The Netherlands (PMH33).