title: Long-acting olanzapine versus long-acting risperidone for schizophrenia in Spain - a cost-effectiveness comparison.
abstract: BACKGROUND
  In schizophrenia, medication adherence is critical to achieve better patient outcomes and to avoid relapses, which are responsible for a significant proportion of total healthcare costs for this chronic illness. The aim of this study was to assess the cost-effectiveness of olanzapine long-acting injection (OLAI) compared with risperidone long-acting injection (RLAI) in patients with schizophrenia in Spain.
  
  
  METHODS
  A discrete event simulation (DES) model was developed from a Spanish healthcare system perspective to estimate clinical and economic outcomes for patients with schizophrenia over a five-year period. Patients who had earlier responded to oral medication and have a history of relapse due to adherence problems were considered. Identical model populations were treated with either OLAI or RLAI. In the absence of a head-to-head clinical trial, discontinuation and relapse rates were obtained from open-label studies. The model accounted for age, gender, risks of relapse and discontinuation, relapse management, hospitalization, treatment switching and adverse events. Direct medical costs for the year 2011 and outcomes including relapse avoided, life years (LYs), and quality-adjusted life years (QALYs) were discounted at a rate of 3%.
  
  
  RESULTS
  When comparing RLAI and OLAI, the model predicts that OLAI would decrease 5-year costs by €2,940 (Standard Deviation between replications 300.83), and result in a QALY and LY gains of 0.07 (SD 0.019) and 0.04 (SD 0.025), respectively. Patients on OLAI had fewer relapses compared to RLAI (1.392 [SD 0.035] vs. 1.815 [SD 0.035]) and fewer discontinuations (1.222 [SD 0.031] vs. 1.710 [SD 0.039]). Sensitivity analysis indicated that the study was robust and conclusions were largely unaffected by changes in a wide range of parameters.
  
  
  CONCLUSIONS
  The present evaluation results in OLAI being dominant over RLAI, meaning that OLAI represents a more effective and less costly alternative compared to RLAI in the treatment of patients with schizophrenia in the Spanish setting.
authors.affiliation: Eli Lilly Spain, Av. de la Industria, 30, 28108, Alcobendas, Madrid, Spain. dilla_tatiana@lilly.com.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Dilla
authors.affiliation: Evidera, 1 Butterwick, Hammersmith, London, W6 8DL, UK. jorgen.moller@evidera.com.
authors.forename: Jörgen
authors.initials: J
authors.lastname: Möller
authors.affiliation: CRF Health, 229-243 Brook House, Shepherds Bush Road, London, W6 7AN, UK. paul.odonohoe@crfhealth.com.
authors.forename: Paul
authors.initials: P
authors.lastname: O'Donohoe
authors.affiliation: Eli Lilly Spain, Av. de la Industria, 30, 28108, Alcobendas, Madrid, Spain. alvarez_orozco_maria@lilly.com.
authors.forename: María
authors.initials: M
authors.lastname: Álvarez
authors.affiliation: Eli Lilly Spain, Av. de la Industria, 30, 28108, Alcobendas, Madrid, Spain. sacristan_jose@lilly.com.
authors.forename: José A
authors.initials: JA
authors.lastname: Sacristán
authors.affiliation: Eli Lilly Deutschland GmbH, Werner-Reimers-Strasse 2-4, 61352, Bad Homburg, Germany. happich_michael@lilly.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Happich
authors.affiliation: Eli Lilly UK, Erl Wood Manor, Sunninghill Road, Windlesham, Surrey, GU20 6PH, UK. tockhorn_antje@lilly.com.
authors.forename: Antje
authors.initials: A
authors.lastname: Tockhorn
mesh_terms: D000368:Aged; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000191:economics*; D001569:Benzodiazepines / Q000008:administration & dosage / Q000191:economics*; D003362:Cost-Benefit Analysis / Q000639:trends; D003692:Delayed-Action Preparations / Q000008:administration & dosage / Q000191:economics; D005260:Female; D017048:Health Care Costs / Q000639:trends; D006760:Hospitalization / Q000191:economics / Q000639:trends; D006801:Humans; D008297:Male; D000077152:Olanzapine; D018967:Risperidone / Q000008:administration & dosage / Q000191:economics*; D012559:Schizophrenia / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D013030:Spain / Q000453:epidemiology
chemical_list: D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations; D001569:Benzodiazepines; D018967:Risperidone; D000077152:Olanzapine