Cost-Effectiveness of Aripiprazole Tablets with Sensor versus Oral Atypical Antipsychotics for the Treatment of Schizophrenia Using a Patient-Level Microsimulation Modeling Approach

Objective Strategies designed to track drug ingestion may improve medication adherence and clinical outcomes in adults with schizophrenia. This study aimed to estimate the cost-effectiveness of aripiprazole tablets with sensor (AS; Abilify MyCite®) versus generic oral atypical antipsychotics (AAPs) in schizophrenia from the United States payer and societal perspectives over 12 months. Methods An individual-level microsimulation was developed to generate individual trajectories using data from a phase 3b multicenter, open-label, mirror-image trial in adults with schizophrenia treated prospectively for 6 months with AS. The patient’s clinical characteristics and outcomes were computed as a function of the Positive and Negative Syndrome Scale (PANSS) scores. Direct and indirect medical cost estimates were sourced from the literature; EuroQol 5-Dimensions (EQ-5D) utilities were derived using risk equations based on patient and clinical characteristics. Scenario analyses were also conducted to assess outcomes under the assumption of treatment durability over 12 months. Results Over 12 months, AS showed a 12.2% improvement in PANSS score. AS had an incremental cost of $2168 and incremental cost savings of $22,343 from the payer and societal perspectives, respectively, with an incremental quality-adjusted life-year (QALY) gain of 0.0298 versus oral AAPs. Further, AS resulted in a 28.2% reduction in hospitalizations over 12 months. At a willingness-to-pay of $100,000 per QALY, the net monetary benefit over 12 months was $25,323 from the payer perspective. Under the assumption of the durability of the treatment effect of AS, the findings were similar to those of the base case analyses, though with greater cost savings and QALYs gained with AS. The results from the sensitivity analyses were consistent with those of the base case analysis. Conclusion AS may be a cost-effective strategy, with lower costs and improved quality of life among patients with schizophrenia over 12 months, from the payer and societal perspectives.

[1]  G. R. Williams,et al.  The Economic Burden of Schizophrenia in the United States. , 2022, The Journal of clinical psychiatry.

[2]  J. Knights,et al.  Phase 3b Multicenter, Prospective, Open-label Trial to Evaluate the Effects of a Digital Medicine System on Inpatient Psychiatric Hospitalization Rates for Adults With Schizophrenia. , 2022, The Journal of clinical psychiatry.

[3]  P. Tappenden,et al.  Cost and health impacts of adherence to the National Institute for Health and Care Excellence schizophrenia guideline recommendations , 2020, The British Journal of Psychiatry.

[4]  A. Young,et al.  The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia. , 2020, The American journal of psychiatry.

[5]  J. Xuan,et al.  Cost-effectiveness of aripiprazole orally disintegrating tablets in the treatment of schizophrenia in China , 2020, Expert review of pharmacoeconomics & outcomes research.

[6]  N. Kaufman.  Digital Therapeutics: Leading the Way to Improved Outcomes for People With Diabetes , 2019, Diabetes Spectrum.

[7]  David G. Mitchell,et al.  Navigating the Wild West of Medication Adherence Reporting in Specialty Pharmacy. , 2019, Journal of managed care & specialty pharmacy.

[8]  M. Kamusheva,et al.  Costs and outcomes for individuals with psychosis prior to hospital admission and following discharge in Bulgaria , 2019, Social Psychiatry and Psychiatric Epidemiology.

[9]  J. Knights,et al.  Evaluating digital medicine ingestion data from seriously mentally ill patients with a Bayesian Hybrid Model , 2019, npj Digital Medicine.

[10]  G. Simon,et al.  Mortality Rates After the First Diagnosis of Psychotic Disorder in Adolescents and Young Adults , 2018, JAMA psychiatry.

[11]  R. Heinssen,et al.  Twelve-Month Health Care Use and Mortality in Commercially Insured Young People With Incident Psychosis in the United States , 2017, Schizophrenia bulletin.

[12]  E. Balman,et al.  National Institute for Health and Care Excellence (NICE) , 2017, The Grants Register 2022.

[13]  C. McCoy,et al.  Understanding the Intention-to-treat Principle in Randomized Controlled Trials , 2017, The western journal of emergency medicine.

[14]  P. Weiden,et al.  Expert Consensus Survey on Medication Adherence in Psychiatric Patients and Use of a Digital Medicine System. , 2017, The Journal of clinical psychiatry.

[15]  C. François,et al.  The Economic Burden of Schizophrenia in the United States in 2013. , 2016, The Journal of clinical psychiatry.

[16]  M. Olfson,et al.  Premature Mortality Among Adults With Schizophrenia in the United States. , 2015, JAMA psychiatry.

[17]  T. Greenwood,et al.  The impact of clinical heterogeneity in schizophrenia on genomic analyses , 2015, Schizophrenia Research.

[18]  J. Maurino,et al.  Impact of negative symptoms on healthcare resource utilization and associated costs in adult outpatients with schizophrenia: a population-based study , 2014, BMC Psychiatry.

[19]  Jan Scott,et al.  Patient Related Outcome Measures Dovepress Nonadherence with Antipsychotic Medication in Schizophrenia: Challenges and Management Strategies , 2022 .

[20]  L. Citrome,et al.  Cost-effectiveness of aripiprazole once-monthly compared with paliperidone palmitate once-monthly injectable for the treatment of schizophrenia in the United States , 2014, Journal of medical economics.

[21]  R. Rosenheck,et al.  Psychiatric comorbidity among adults with schizophrenia: A latent class analysis , 2013, Psychiatry Research.

[22]  J. Kane,et al.  Hospitalisation rates in patients switched from oral anti-psychotics to aripiprazole once-monthly for the management of schizophrenia , 2013, Journal of medical economics.

[23]  T. Dilla,et al.  Systematic review of the economic aspects of nonadherence to antipsychotic medication in patients with schizophrenia , 2013, Patient preference and adherence.

[24]  Jay Lin,et al.  Impact of Early Nonadherence to Oral Antipsychotics on Clinical and Economic Outcomes Among Patients with Schizophrenia , 2013, Advances in Therapy.

[25]  Uwe Siebert,et al.  Modeling good research practices--overview: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force--1. , 2012, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[26]  D. Owens,et al.  State-transition modeling: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force--3. , 2012, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[27]  R. Conley,et al.  Cost-effectiveness of several atypical antipsychotics in orally disintegrating tablets compared with standard oral tablets in the treatment of schizophrenia in the United States , 2012, Journal of medical economics.

[28]  R. Reves,et al.  Early clinical experience with networked system for promoting patient self-management. , 2011, The American journal of managed care.

[29]  Stefan Leucht,et al.  Oral versus depot antipsychotic drugs for schizophrenia—A critical systematic review and meta-analysis of randomised long-term trials , 2011, Schizophrenia Research.

[30]  R. Conley,et al.  Cost Effectiveness and Resource Allocation Cost-effectiveness Model Comparing Olanzapine and Other Oral Atypical Antipsychotics in the Treatment of Schizophrenia in the United States , 2022 .

[31]  S. Chick,et al.  A taxonomy of model structures for economic evaluation of health technologies. , 2006, Health economics.

[32]  Teresa Hudson,et al.  Annual prevalence of diagnosed schizophrenia in the USA: a claims data analysis approach , 2006, Psychological Medicine.

[33]  Olga V. Demler,et al.  The Prevalence and Correlates of Nonaffective Psychosis in the National Comorbidity Survey Replication (NCS-R) , 2005, Biological Psychiatry.

[34]  V Shane Pankratz,et al.  The lifetime risk of suicide in schizophrenia: a reexamination. , 2005, Archives of general psychiatry.

[35]  Mark S Roberts,et al.  Simulation and critical care modeling , 2004, Current opinion in critical care.

[36]  Joseph J. LaViola,et al.  Double exponential smoothing: an alternative to Kalman filter-based predictive tracking , 2003, IPT/EGVE.

[37]  M. Cowie.  National Institute for Health and Care Excellence. , 2015, European heart journal.

[38]  M. Mimura,et al.  Long-acting injectable vs oral antipsychotics for relapse prevention in schizophrenia: a meta-analysis of randomized trials. , 2014, Schizophrenia bulletin.