title: Cost-effectiveness of lurasidone vs aripiprazole among patients with schizophrenia who have previously failed on an atypical antipsychotic: an indirect comparison of outcomes from clinical trial data.
abstract: OBJECTIVE
  Compare long-term costs and outcomes of lurasidone to aripiprazole among adults with schizophrenia in the US who previously failed ≥1 atypical antipsychotic (olanzapine, risperidone, quetiapine, or ziprasidone) based on an indirect comparison of outcomes data from clinical trials.
  
  
  METHODS
  A 5-year Markov cohort model was developed to compare long-term effectiveness of lurasidone to aripiprazole, including total discontinuations, relapse rates, and hospitalization rates. Cost inputs included pharmacy, mental health, and medical costs associated with cardiometabolic risks (diabetes and cardiovascular [CV] events). Effectiveness inputs were derived from an indirect comparison of aripiprazole and lurasidone using common comparators from CATIE. Cardiometabolic risks were derived from claims data analysis for diabetes, weight change and CV events, and Framingham body mass index (BMI) risk equation. Cost inputs were derived from published sources and Red Book. Costs and outcomes were discounted at 3% and tested with sensitivity analyses.
  
  
  RESULTS
  Over 5 years, total discounted costs for lurasidone and aripiprazole patients were $86,480 and $90,500, respectively. During this period, the number of relapses per patient, hospitalizations per patient, diabetes rates, and CV events per 1000 patients, respectively, were estimated to be lower for lurasidone (0.442, 0.245, 7.29%, and 37.3) than aripiprazole (0.478, 0.369, 7.36%, and 37.8). Results were sensitive to lurasidone and aripiprazole hospitalization rates. At a willingness-to-pay threshold of $50,000 per hospitalization avoided, lurasidone had a 100% probability of being more cost-effective than aripiprazole.
  
  
  CONCLUSIONS
  The model was based on results from various comparative clinical trials. Differences in patient population and study methods may change estimates from the model. The model does not account for patient heterogeneity.
  
  
  CONCLUSIONS
  Based on this model, when switching from another atypical antipsychotic, lurasidone had fewer relapses and hospitalizations with a lower incidence of diabetes and CV events than aripiprazole. Additionally, lurasidone may be less costly than aripiprazole among adults with schizophrenia.
authors.affiliation: Sunovion Pharmaceuticals Inc., Marlborough, MA, USA.
authors.forename: Krithika
authors.initials: K
authors.lastname: Rajagopalan
authors.forename: Mariam
authors.initials: M
authors.lastname: Hassan
authors.forename: Ken
authors.initials: K
authors.lastname: O'Day
authors.forename: Kellie
authors.initials: K
authors.lastname: Meyer
authors.forename: Fred
authors.initials: F
authors.lastname: Grossman
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D000068180:Aripiprazole; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000191:economics; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D003024:Clozapine / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D003920:Diabetes Mellitus / Q000139:chemically induced / Q000191:economics; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D054833:Isoindoles / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D000069056:Lurasidone Hydrochloride; D008390:Markov Chains; D018803:Models, Economic; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010879:Piperazines / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D015363:Quinolones / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D012008:Recurrence; D012559:Schizophrenia / Q000150:complications / Q000188:drug therapy* / Q000191:economics*; D013844:Thiazoles / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D014481:United States
chemical_list: D014150:Antipsychotic Agents; D054833:Isoindoles; D010879:Piperazines; D015363:Quinolones; D013844:Thiazoles; D000068180:Aripiprazole; D003024:Clozapine; D000069056:Lurasidone Hydrochloride