Cost-effectiveness of asenapine in the treatment of bipolar disorder in Canada.
BACKGROUND
Bipolar disorder (BPD) is prevalent and is associated with a significant economic burden. Asenapine, the first tetracyclic antipsychotic approved in Canada for the treatment of BPD, has shown a comparable efficacy profile to other atypical antipsychotics. In addition, it is associated with a favourable metabolic profile and minimal weight gain potential. This study aimed to assess the economic impact of asenapine compared to olanzapine in the treatment of BPD in Canada.


METHODS
A decision tree combined with a Markov model was constructed to assess the cost-utility of asenapine compared with olanzapine. The decision tree takes into account the occurrence of extrapyramidal symptoms (EPS), the probability of switching to a different antipsychotic, and the probability of gaining weight. The Markov model takes into account long-term metabolic complications including diabetes, hypertension, coronary heart diseases (CHDs), and stroke. Analyses were conducted from both a Canadian Ministry of Health (MoH) and a societal perspective over a five-year time horizon with yearly cycles.


RESULTS
In the treatment of BPD, asenapine is a dominant strategy over olanzapine from both a MoH and a societal perspective. In fact, asenapine is associated with lower costs and more quality-adjusted life years (QALYs). Results of the probabilistic sensitivity analysis indicated that asenapine remains a dominant strategy in 99.2% of the simulations, in both a MoH and a societal perspective, and this result is robust to the many deterministic sensitivity analyses performed.


CONCLUSIONS
This economic evaluation demonstrates that asenapine is a cost-effective strategy compared to olanzapine in the treatment of BPD in Canada.
Faculty of Pharmacy, University of Montreal, Station Centre-ville, PO Box 6128, H3C 3 J7 Montreal, Quebec, Canada. Jean.lachaine@umontreal.ca.
Jean
J
Lachaine
Catherine
C
Beauchemin
Karine
K
Mathurin
Dominique
D
Gilbert
Maud
M
Beillat
D014150:Antipsychotic Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D001569:Benzodiazepines / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy*; D002170:Canada; D003362:Cost-Benefit Analysis; D003986:Dibenzocycloheptenes; D006576:Heterocyclic Compounds, 4 or More Rings / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D000077152:Olanzapine; D019057:Quality-Adjusted Life Years; D015430:Weight Gain / Q000187:drug effects
D014150:Antipsychotic Agents; D003986:Dibenzocycloheptenes; D006576:Heterocyclic Compounds, 4 or More Rings; D001569:Benzodiazepines; C522667:asenapine; D000077152:Olanzapine