title: The threshold rate of oral atypical anti-psychotic adherence at which paliperidone palmitate is cost saving.
abstract: OBJECTIVE
  To identify, estimate, and compare 'real world' costs and outcomes associated with paliperidone palmitate compared with branded oral atypical anti-psychotics, and to estimate the threshold rate of oral atypical adherence at which paliperidone palmitate is cost saving.
  
  
  METHODS
  Decision analytic modeling techniques developed by Glazer and Ereshefsky have previously been used to estimate the cost-effectiveness of depot haloperidol, LAI risperidone, and, more recently, LAI olanzapine. This study used those same techniques, along with updated comparative published clinical data, to evaluate paliperidone palmitate. Adherence rates were based on strict Medication Event Monitoring System (MEMS) criteria. The evaluation was conducted from the perspective of US healthcare payers.
  
  
  RESULTS
  Paliperidone palmitate patients had fewer mean annual days of relapse (8.7 days; 6.0 requiring hospitalization, 2.7 not requiring hospitalization vs 17.8 days; 12.4 requiring hospitalization, 5.4 not requiring hospitalization), and lower annual total cost ($20,995) compared to oral atypicals (mean $22,481). Because paliperidone palmitate was both more effective and less costly, it is considered economically dominant. Paliperidone palmitate saved costs when the rate of adherence of oral atypical anti-psychotics was below 44.9% using strict MEMS criteria. Sensitivity analyses showed results were robust to changes in parameter values. For patients receiving 156 mg paliperidone palmitate, the annual incremental cost was $1216 per patient (ICER = $191 per day of relapse averted). Inclusion of generic risperidone (market share 18.6%) also resulted in net incremental cost for paliperidone palmitate ($120; ICER = $13). Limitations of this evaluation include use of simplifying assumptions, data from multiple sources, and generalizability of results.
  
  
  CONCLUSIONS
  Although uptake of LAIs in the US has not been as rapid as elsewhere, many thought leaders emphasize their importance in optimizing outcomes in patients with adherence problems. The findings of this analysis support the cost-effectiveness of paliperidone palmitate in these patients.
authors.affiliation: Health Services Consulting Corporation, Boxborough, MA 01719, USA. natalie.edwards@earthlink.net
authors.forename: Natalie C
authors.initials: NC
authors.lastname: Edwards
authors.forename: Erik
authors.initials: E
authors.lastname: Muser
authors.forename: Dilesh
authors.initials: D
authors.lastname: Doshi
authors.forename: John
authors.initials: J
authors.lastname: Fastenau
mesh_terms: D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics*; D017046:Cost Savings / Q000191:economics*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003692:Delayed-Action Preparations / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D007555:Isoxazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics*; D055118:Medication Adherence; D000068882:Paliperidone Palmitate; D010168:Palmitates / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics*
chemical_list: D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations; D007555:Isoxazoles; D010168:Palmitates; D000068882:Paliperidone Palmitate