title: Cost effectiveness of paliperidone palmitate versus risperidone long-acting injectable and olanzapine pamoate for the treatment of patients with schizophrenia in Sweden.
abstract: OBJECTIVE
  To model the cost effectiveness of paliperidone palmitate (paliperidone long-acting injectable; PLAI), a new once-monthly long-acting antipsychotic therapy, compared with risperidone long-acting injectable (RLAI) and olanzapine pamoate (OLAI), in multi-episode patients (two or more relapses) with schizophrenia in Sweden.
  
  
  METHODS
  A Markov decision analytic model was developed to simulate the history of a cohort of multi-episode patients transitioning through different health states on a monthly basis over a 5-year time horizon from the perspective of the Swedish healthcare system. Therapeutic strategies consisted of starting treatment with RLAI (mean dose 37.5 mg every 2 weeks), PLAI (mean dose 75 mg equivalent (eq.) every month) or OLAI (150 mg every 2 weeks or 300 mg every 4 weeks). Probability of relapse, level of adherence, side-effects (extrapyramidal symptoms, tardive dyskinesia, weight gain and diabetes) and treatment discontinuation (switch) were derived from long-term observational data when feasible. Incremental cost-effectiveness outcomes, discounted at 3% annually, included cost per quality-adjusted life-year (QALY) and cost per relapse avoided (expressed in 2009 Swedish Krona SEK).
  
  
  RESULTS
  Relative to RLAI and OLAI, PLAI is economically dominant: more effective (additional QALYs, less relapses) and less costly treatment option over a 5-year time horizon. The results were robust when tested in sensitivity analysis.
  
  
  CONCLUSIONS
  The impact of once-monthly treatment on adherence levels is not yet known, and not all variables that could impact on real-world outcomes and costs were included in this model.
  
  
  CONCLUSIONS
  PLAI was cost saving from a Swedish payer perspective compared with RLAI and OLAI in the long-term treatment of multi-episode (two or more relapses) schizophrenia patients.
authors.affiliation: Janssen Pharmaceutica N.V., Belgium. amehner1@its.jnj.com
authors.forename: Angelika
authors.initials: A
authors.lastname: Mehnert
authors.forename: Deborah
authors.initials: D
authors.lastname: Nicholl
authors.forename: Hanna
authors.initials: H
authors.lastname: Pudas
authors.forename: Monique
authors.initials: M
authors.lastname: Martin
authors.forename: Alistair
authors.initials: A
authors.lastname: McGuire
mesh_terms: D014150:Antipsychotic Agents / Q000191:economics* / Q000627:therapeutic use; D001569:Benzodiazepines / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D057915:Drug Substitution; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D007267:Injections / Q000191:economics; D007555:Isoxazoles / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D008390:Markov Chains; D018803:Models, Economic; D000077152:Olanzapine; D000068882:Paliperidone Palmitate; D010168:Palmitates / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D012008:Recurrence; D018967:Risperidone / Q000191:economics* / Q000627:therapeutic use; D012559:Schizophrenia / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D013548:Sweden / Q000453:epidemiology
chemical_list: D014150:Antipsychotic Agents; D007555:Isoxazoles; D010168:Palmitates; D001569:Benzodiazepines; D018967:Risperidone; D000077152:Olanzapine; D000068882:Paliperidone Palmitate