Cost-effectiveness of brexpiprazole adjunctive treatment for major depressive disorder.
Major depressive disorder (MDD) is a debilitating psychiatric illness with a high cost burden. This analysis evaluates the cost-effectiveness of adjunctive brexpiprazole versus comparator branded adjunctive treatment for MDD and background antidepressant therapy (ADT) alone from a US payer perspective.



An economic model was developed to assess the cost-effectiveness of brexpiprazole versus comparator adjunctive treatment and ADT alone on total direct medical costs using a 6-week cycle time frame for a total of 48 weeks, with treatment response and remission as primary outcomes. The model consisted of 3 parts, 1 to represent the acute treatment phase and 2 to represent the maintenance stage.



In the base-case analysis, brexpiprazole as reference treatment resulted in cost per additional responder ranging from $19,442-$48,745 and cost per additional remitter ranging from $27,196-$71,839 versus comparator treatments over 48 weeks. Sensitivity analyses showed treatment with brexpiprazole was more costly, but more clinically effective in all probabilistic simulations.



This representation of disease natural history over 48 weeks may not account for all possible health states. Resource utilization on treatment was estimated using the resource use data from previous trials, and may overestimate medical costs compared to the real-world setting. Treatment comparators were limited to branded therapies, and head-to-head studies were not available to obtain data inputs.



Compared to other branded adjunctive therapies, brexpiprazole increases response and remission at 6 weeks; medical care cost savings were observed with the use of brexpiprazole. These findings may assist clinicians and formulary decision makers when selecting treatment for MDD.
Boston Health Economics, Waltham, MA, United States.
Matthew
M
Sussman
Boston Health Economics, Waltham, MA, United States.
Jeffrey
J
Yu
Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, United States.
Siddhesh A
SA
Kamat
Lundbeck LLC, Deerfield, IL, United States.
Ann
A
Hartry
Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, United States.
Susan
S
Legacy
Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, United States.
Ruth
R
Duffy
Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, United States. Electronic address: myrlene.sanon@otsuka-us.com.
Myrlene Sanon
MS
Aigbogun
D000293:Adolescent; D000328:Adult; D000368:Aged; D017109:Akathisia, Drug-Induced / Q000191:economics / Q000209:etiology; D000928:Antidepressive Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000191:economics; D006970:Disorders of Excessive Somnolence / Q000139:chemically induced / Q000191:economics; D016527:Drug Costs; D004359:Drug Therapy, Combination; D005221:Fatigue / Q000139:chemically induced / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D000077152:Olanzapine; D018579:Patient Selection; D000069348:Quetiapine Fumarate / Q000627:therapeutic use; D015363:Quinolones / Q000191:economics / Q000627:therapeutic use*; D018490:Serotonin Agents / Q000191:economics / Q000627:therapeutic use*; D013876:Thiophenes / Q000191:economics / Q000627:therapeutic use*; D015430:Weight Gain; D055815:Young Adult
D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D015363:Quinolones; D018490:Serotonin Agents; D013876:Thiophenes; D001569:Benzodiazepines; C000591922:brexpiprazole; D000069348:Quetiapine Fumarate; D000077152:Olanzapine
Adjunctive therapy; Atypical antipsychotics; Brexpiprazole; Cost-effectiveness; Major depressive disorder; Remission