title: Pharmacoeconomics of depot antipsychotics for treating chronic schizophrenia in Sweden.
abstract: OBJECTIVE
  To determine the cost-effectiveness of long-acting injectable (LAI) antipsychotics for chronic schizophrenia in Sweden.
  
  
  METHODS
  A 1-year decision tree was developed for Sweden using published data and expert opinion. Five treatment strategies lasting 1 year were compared: paliperidone palmitate (PP-LAI), olanzapine pamoate (OLZ-LAI), risperidone (RIS-LAI), haloperidol decanoate (HAL-LAI) and olanzapine tablets (oral-OLZ). Patients intolerant/failing drugs switched to another depot; subsequent failures received clozapine. Resources and employment time lost (indirect costs) were costed in 2011 Swedish kroner (SEK), from standard government lists. The model calculated the average cost/patient and quality-adjusted life-years (QALYs), which were combined into incremental cost-effectiveness ratios. Multivariate and 1-way sensitivity analyses tested model stability.
  
  
  RESULTS
  PP-LAI followed by OLZ-LAI had the lowest cost/patient (189,696 SEK) and highest QALYs (0.817), dominating in the base case. OLZ-LAI followed by PP-LAI cost 229,775 SEK (0.812 QALY), RIS-LAI followed by HAL-LAI cost 221,062 SEK (0.804 QALY), HAL-LAI followed by oral-OLZ cost 243,411 SEK (0.776 QALY), and oral-OLZ followed by HAL-LAI cost 249,422 SEK (0.773 QALY). The greatest proportions of costs (52.5-83.8%) were for institutional care; indirect costs were minor (2.4-3.8%). RESULTS were sensitive to adherence and hospitalization rates, but not drug cost. PP-LAI followed by OLZ-LAI dominated OLZ-LAI followed by PP-LAI in 59.4% of simulations, RIS-LAI followed by HAL-LAI in 65.8%, HAL-LAI followed by oral-OLZ in 94.0% and oral-OLZ followed by HAL-LAI in 95.9%; PP-LAI followed by OLZ-LAI was dominated in 1.1% of the 40,000 iterations.
  
  
  CONCLUSIONS
  PP-LAI followed by OLZ-LAI was cost-effective in Sweden for chronic schizophrenia and cost-saving overall to the healthcare system.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Einarson
authors.forename: Colin
authors.initials: C
authors.lastname: Vicente
authors.forename: Roman
authors.initials: R
authors.lastname: Zilbershtein
authors.forename: Charles
authors.initials: C
authors.lastname: Piwko
authors.forename: Christel N
authors.initials: CN
authors.lastname: Bø
authors.forename: Hanna
authors.initials: H
authors.lastname: Pudas
authors.forename: Rasmus
authors.initials: R
authors.lastname: Jensen
authors.forename: Michiel E H
authors.initials: ME
authors.lastname: Hemels
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000191:economics* / Q000627:therapeutic use; D001569:Benzodiazepines / Q000191:economics / Q000627:therapeutic use; D003024:Clozapine / Q000191:economics / Q000627:therapeutic use; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003692:Delayed-Action Preparations; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D006220:Haloperidol / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D017048:Health Care Costs / Q000706:statistics & numerical data; D006760:Hospitalization; D006801:Humans; D007555:Isoxazoles / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D000077152:Olanzapine; D000068882:Paliperidone Palmitate; D010168:Palmitates / Q000191:economics / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D018967:Risperidone / Q000191:economics / Q000627:therapeutic use; D012559:Schizophrenia / Q000188:drug therapy* / Q000191:economics*; D013548:Sweden
chemical_list: D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations; D007555:Isoxazoles; D010168:Palmitates; D001569:Benzodiazepines; C033563:haloperidol decanoate; D003024:Clozapine; D006220:Haloperidol; D018967:Risperidone; D000077152:Olanzapine; D000068882:Paliperidone Palmitate
keywords: Olanzapine pamoate; Paliperidone palmitate; Pharmacoeconomic analysis; Schizophrenia; Sweden