title: Cost-Effectiveness of Long-Acting Injectable Paliperidone Palmitate Versus Haloperidol Decanoate in Maintenance Treatment of Schizophrenia.
abstract: This study assessed the relative cost-effectiveness of haloperidol decanoate (HD), a first-generation long-acting injectable (LAI) antipsychotic, and paliperidone palmitate (PP), a second-generation LAI antipsychotic.
  
  
  
  A double-blind, randomized 18-month clinical trial conducted at 22 clinical research sites in the United States compared the cost-effectiveness of HD and PP among 311 adults with schizophrenia or schizoaffective disorder who had been clinically assessed as likely to benefit from an LAI antipsychotic. Patients were randomly assigned to monthly intramuscular injections of HD (25-200 mg) or PP (39-234 mg) for up to 24 months. Quality-adjusted life years (QALYs) were measured by a schizophrenia-specific algorithm based on the Positive and Negative Syndrome Scale and side-effect assessments; total health care costs were assessed from the perspective of the health system.
  
  
  
  Mixed-model analysis showed that PP was associated with .0297 greater QALYs over 18 months (p=.03) and with $2,100 more in average costs per quarter for inpatient and outpatient services and medication compared with HD (p<.001). Bootstrap analysis with 5,000 replications showed an incremental cost-effectiveness ratio for PP of $508,241 per QALY (95% confidence interval=$122,390-$1,582,711). Net health benefits analysis showed a .98 probability of greater cost-effectiveness for HD compared with PP at an estimated value of $150,000 per QALY and a .50 probability of greater cost-effectiveness at $500,000 per QALY.
  
  
  
  HD was more cost-effective than PP, suggesting that PP's slightly greater benefits did not justify its markedly higher costs, which are likely to fall once the medication's patent expires.
authors.affiliation: Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the U.S. Department of Veterans Affairs New England Mental Illness Research, Education and Clinical Center, West Haven (e-mail: robert.rosenheck@yale.edu ). Dr. Leslie is with the Department of Public Health Sciences and Psychiatry, Penn State University College of Medicine, Hershey, Pennsylvania. Mr. Sint, Dr. Lin, and Mr. Li are with the Yale School of Public Health, New Haven, Connecticut. Dr. McEvoy is with the Medical College of Georgia, Georgia Regents University, Augusta. Dr. Byerly is with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas. Dr. Hamer, who is deceased, was with the Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, at the time of this study. He was a beloved colleague, and we will miss his friendship, intelligence, and collegiality and will remember his special contributions to our field. Dr. Swartz is with the Department of Psychiatry, Duke University Medical Center, Durham, North Carolina. Dr. Stroup is with the Columbia University College of Physicians and Surgeons, New York.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Rosenheck
authors.affiliation: Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the U.S. Department of Veterans Affairs New England Mental Illness Research, Education and Clinical Center, West Haven (e-mail: robert.rosenheck@yale.edu ). Dr. Leslie is with the Department of Public Health Sciences and Psychiatry, Penn State University College of Medicine, Hershey, Pennsylvania. Mr. Sint, Dr. Lin, and Mr. Li are with the Yale School of Public Health, New Haven, Connecticut. Dr. McEvoy is with the Medical College of Georgia, Georgia Regents University, Augusta. Dr. Byerly is with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas. Dr. Hamer, who is deceased, was with the Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, at the time of this study. He was a beloved colleague, and we will miss his friendship, intelligence, and collegiality and will remember his special contributions to our field. Dr. Swartz is with the Department of Psychiatry, Duke University Medical Center, Durham, North Carolina. Dr. Stroup is with the Columbia University College of Physicians and Surgeons, New York.
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Leslie
authors.affiliation: Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the U.S. Department of Veterans Affairs New England Mental Illness Research, Education and Clinical Center, West Haven (e-mail: robert.rosenheck@yale.edu ). Dr. Leslie is with the Department of Public Health Sciences and Psychiatry, Penn State University College of Medicine, Hershey, Pennsylvania. Mr. Sint, Dr. Lin, and Mr. Li are with the Yale School of Public Health, New Haven, Connecticut. Dr. McEvoy is with the Medical College of Georgia, Georgia Regents University, Augusta. Dr. Byerly is with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas. Dr. Hamer, who is deceased, was with the Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, at the time of this study. He was a beloved colleague, and we will miss his friendship, intelligence, and collegiality and will remember his special contributions to our field. Dr. Swartz is with the Department of Psychiatry, Duke University Medical Center, Durham, North Carolina. Dr. Stroup is with the Columbia University College of Physicians and Surgeons, New York.
authors.forename: Kyaw J
authors.initials: KJ
authors.lastname: Sint
authors.affiliation: Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the U.S. Department of Veterans Affairs New England Mental Illness Research, Education and Clinical Center, West Haven (e-mail: robert.rosenheck@yale.edu ). Dr. Leslie is with the Department of Public Health Sciences and Psychiatry, Penn State University College of Medicine, Hershey, Pennsylvania. Mr. Sint, Dr. Lin, and Mr. Li are with the Yale School of Public Health, New Haven, Connecticut. Dr. McEvoy is with the Medical College of Georgia, Georgia Regents University, Augusta. Dr. Byerly is with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas. Dr. Hamer, who is deceased, was with the Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, at the time of this study. He was a beloved colleague, and we will miss his friendship, intelligence, and collegiality and will remember his special contributions to our field. Dr. Swartz is with the Department of Psychiatry, Duke University Medical Center, Durham, North Carolina. Dr. Stroup is with the Columbia University College of Physicians and Surgeons, New York.
authors.forename: Haiqun
authors.initials: H
authors.lastname: Lin
authors.affiliation: Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the U.S. Department of Veterans Affairs New England Mental Illness Research, Education and Clinical Center, West Haven (e-mail: robert.rosenheck@yale.edu ). Dr. Leslie is with the Department of Public Health Sciences and Psychiatry, Penn State University College of Medicine, Hershey, Pennsylvania. Mr. Sint, Dr. Lin, and Mr. Li are with the Yale School of Public Health, New Haven, Connecticut. Dr. McEvoy is with the Medical College of Georgia, Georgia Regents University, Augusta. Dr. Byerly is with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas. Dr. Hamer, who is deceased, was with the Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, at the time of this study. He was a beloved colleague, and we will miss his friendship, intelligence, and collegiality and will remember his special contributions to our field. Dr. Swartz is with the Department of Psychiatry, Duke University Medical Center, Durham, North Carolina. Dr. Stroup is with the Columbia University College of Physicians and Surgeons, New York.
authors.forename: Yue
authors.initials: Y
authors.lastname: Li
authors.affiliation: Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the U.S. Department of Veterans Affairs New England Mental Illness Research, Education and Clinical Center, West Haven (e-mail: robert.rosenheck@yale.edu ). Dr. Leslie is with the Department of Public Health Sciences and Psychiatry, Penn State University College of Medicine, Hershey, Pennsylvania. Mr. Sint, Dr. Lin, and Mr. Li are with the Yale School of Public Health, New Haven, Connecticut. Dr. McEvoy is with the Medical College of Georgia, Georgia Regents University, Augusta. Dr. Byerly is with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas. Dr. Hamer, who is deceased, was with the Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, at the time of this study. He was a beloved colleague, and we will miss his friendship, intelligence, and collegiality and will remember his special contributions to our field. Dr. Swartz is with the Department of Psychiatry, Duke University Medical Center, Durham, North Carolina. Dr. Stroup is with the Columbia University College of Physicians and Surgeons, New York.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: McEvoy
authors.affiliation: Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the U.S. Department of Veterans Affairs New England Mental Illness Research, Education and Clinical Center, West Haven (e-mail: robert.rosenheck@yale.edu ). Dr. Leslie is with the Department of Public Health Sciences and Psychiatry, Penn State University College of Medicine, Hershey, Pennsylvania. Mr. Sint, Dr. Lin, and Mr. Li are with the Yale School of Public Health, New Haven, Connecticut. Dr. McEvoy is with the Medical College of Georgia, Georgia Regents University, Augusta. Dr. Byerly is with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas. Dr. Hamer, who is deceased, was with the Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, at the time of this study. He was a beloved colleague, and we will miss his friendship, intelligence, and collegiality and will remember his special contributions to our field. Dr. Swartz is with the Department of Psychiatry, Duke University Medical Center, Durham, North Carolina. Dr. Stroup is with the Columbia University College of Physicians and Surgeons, New York.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Byerly
authors.affiliation: Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the U.S. Department of Veterans Affairs New England Mental Illness Research, Education and Clinical Center, West Haven (e-mail: robert.rosenheck@yale.edu ). Dr. Leslie is with the Department of Public Health Sciences and Psychiatry, Penn State University College of Medicine, Hershey, Pennsylvania. Mr. Sint, Dr. Lin, and Mr. Li are with the Yale School of Public Health, New Haven, Connecticut. Dr. McEvoy is with the Medical College of Georgia, Georgia Regents University, Augusta. Dr. Byerly is with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas. Dr. Hamer, who is deceased, was with the Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, at the time of this study. He was a beloved colleague, and we will miss his friendship, intelligence, and collegiality and will remember his special contributions to our field. Dr. Swartz is with the Department of Psychiatry, Duke University Medical Center, Durham, North Carolina. Dr. Stroup is with the Columbia University College of Physicians and Surgeons, New York.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Hamer
authors.affiliation: Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the U.S. Department of Veterans Affairs New England Mental Illness Research, Education and Clinical Center, West Haven (e-mail: robert.rosenheck@yale.edu ). Dr. Leslie is with the Department of Public Health Sciences and Psychiatry, Penn State University College of Medicine, Hershey, Pennsylvania. Mr. Sint, Dr. Lin, and Mr. Li are with the Yale School of Public Health, New Haven, Connecticut. Dr. McEvoy is with the Medical College of Georgia, Georgia Regents University, Augusta. Dr. Byerly is with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas. Dr. Hamer, who is deceased, was with the Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, at the time of this study. He was a beloved colleague, and we will miss his friendship, intelligence, and collegiality and will remember his special contributions to our field. Dr. Swartz is with the Department of Psychiatry, Duke University Medical Center, Durham, North Carolina. Dr. Stroup is with the Columbia University College of Physicians and Surgeons, New York.
authors.forename: Marvin S
authors.initials: MS
authors.lastname: Swartz
authors.affiliation: Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the U.S. Department of Veterans Affairs New England Mental Illness Research, Education and Clinical Center, West Haven (e-mail: robert.rosenheck@yale.edu ). Dr. Leslie is with the Department of Public Health Sciences and Psychiatry, Penn State University College of Medicine, Hershey, Pennsylvania. Mr. Sint, Dr. Lin, and Mr. Li are with the Yale School of Public Health, New Haven, Connecticut. Dr. McEvoy is with the Medical College of Georgia, Georgia Regents University, Augusta. Dr. Byerly is with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas. Dr. Hamer, who is deceased, was with the Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, at the time of this study. He was a beloved colleague, and we will miss his friendship, intelligence, and collegiality and will remember his special contributions to our field. Dr. Swartz is with the Department of Psychiatry, Duke University Medical Center, Durham, North Carolina. Dr. Stroup is with the Columbia University College of Physicians and Surgeons, New York.
authors.forename: T Scott
authors.initials: TS
authors.lastname: Stroup
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000191:economics / Q000494:pharmacology*; D003362:Cost-Benefit Analysis; D003692:Delayed-Action Preparations; D004311:Double-Blind Method; D005260:Female; D006220:Haloperidol / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics / Q000494:pharmacology; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D000068882:Paliperidone Palmitate / Q000008:administration & dosage / Q000191:economics / Q000494:pharmacology*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000191:economics; D019057:Quality-Adjusted Life Years; D012559:Schizophrenia / Q000188:drug therapy* / Q000191:economics; D014481:United States; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations; C033563:haloperidol decanoate; D006220:Haloperidol; D000068882:Paliperidone Palmitate