title: Annual cost of relapses and relapse-related hospitalizations in adults with schizophrenia: results from a 12-month, double-blind, comparative study of lurasidone vs quetiapine extended-release.
abstract: OBJECTIVE
  To model the economic impact of annual relapses/relapse-related hospitalizations among adults with schizophrenia treated with lurasidone or quetiapine extended-release (XR).
  
  
  METHODS
  A probabilistic model estimating per-patient-per-year (PPPY) direct mental healthcare (MH) cost differences due to relapses/relapse-related hospitalizations was developed using relapse and relapse-related hospitalization rates from a 12-month, double-blind, parallel-group, global comparison study of lurasidone vs quetiapine XR (all patients previously treated with lurasidone or quetiapine XR for 6 weeks). Analyses were conducted for both all subjects and clinical responders. Direct costs associated with inpatient and outpatient mental healthcare-related services were obtained from a large, prospective, observational study of schizophrenia treatment in usual-care settings for relapsing and non-relapsing patients, including psychiatric hospitalizations, emergency services, medication management, and outpatient individual therapy. Model robustness was tested using univariate and probabilistic sensitivity analyses.
  
  
  RESULTS
  Model-estimated PPPY MH cost savings associated with relapse-related hospitalization rates in all subjects were $3276 for lurasidone vs quetiapine XR. Lurasidone resulted in PPPY MH cost savings of $2702 vs quetiapine XR in all subjects, using relapse rates. Sensitivity analyses indicated lurasidone had lower 1-year MH costs than quetiapine XR in 100% and 99.7% of simulations, using relapse-related hospitalization rates and relapse rates, respectively, in all subjects. Similar results were seen in clinical responders.
  
  
  CONCLUSIONS
  The model represents a simplification of treatment patterns and response to treatment. Cost of treatment with lurasidone and quetiapine XR was not included in the model. Estimates of cost savings are likely conservative, as the model did not assess the impact of long-term cardiometabolic consequences. Indirect costs associated with relapses and non-mental health-related costs were also excluded from the model.
  
  
  CONCLUSIONS
  Adults treated for schizophrenia with lurasidone are predicted to have lower 12-month MH costs compared to those treated with quetiapine XR due to fewer relapses and relapse-related hospitalizations.
authors.affiliation: Sunovion Pharmaceuticals Inc., Marlborough, MA, USA.
authors.forename: Krithika
authors.initials: K
authors.lastname: Rajagopalan
authors.forename: Ken
authors.initials: K
authors.lastname: O'Day
authors.forename: Kellie
authors.initials: K
authors.lastname: Meyer
authors.forename: Andrei
authors.initials: A
authors.lastname: Pikalov
authors.forename: Antony
authors.initials: A
authors.lastname: Loebel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003692:Delayed-Action Preparations; D003987:Dibenzothiazepines / Q000008:administration & dosage / Q000191:economics*; D004311:Double-Blind Method; D005260:Female; D006296:Health Services / Q000191:economics*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D054833:Isoindoles / Q000191:economics* / Q000627:therapeutic use; D000069056:Lurasidone Hydrochloride; D008297:Male; D008605:Mental Health Services / Q000191:economics; D008875:Middle Aged; D018803:Models, Economic; D000069348:Quetiapine Fumarate; D012559:Schizophrenia / Q000188:drug therapy*; D013844:Thiazoles / Q000191:economics* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations; D003987:Dibenzothiazepines; D054833:Isoindoles; D013844:Thiazoles; D000069348:Quetiapine Fumarate; D000069056:Lurasidone Hydrochloride