Cost-effectiveness analysis of aripiprazole vs standard-of-care in the management of community-treated patients with schizophrenia: STAR study

Abstract

Background:

The Schizophrenia Trial of Aripiprazole (STAR) showed superior efficacy for aripiprazole compared with atypical antipsychotic standard-of-care (SOC) for the community treatment of schizophrenia based on the Investigator Assessment Questionnaire total score.

Objective:

To determine the cost-effectiveness of aripiprazole compared with SOC medications from a health and social care system perspective.

Methods:

Information on health and social care service use was collected using the Client Socio-demographic and Service Receipt Inventory (CSSRI). Unit costs attached to each service were used to calculate patients’ healthcare and other costs. The primary outcome measure was Investigator’s Assessment Questionnaire (IAQ) score; secondary measures included the Clinical Global Impression (CGI)-Improvement response and Quality of Life Scale (QLS). Incremental cost-effectiveness was measured over 26 weeks as the ratio of the difference in mean costs between aripiprazole and SOC (olanzapine, quetiapine and risperidone) to the difference in mean outcomes. Net benefit was used to plot the cost-effectiveness acceptability curve.

Results:

The analysis sample (all randomised subjects who met the study inclusion criteria) included 282 individuals randomised to aripiprazole and 266 to SOC (olanzapine, n = 75; quetiapine, n = 110 and risperidone, n = 81). The additional mean cost of achieving a clinically significant difference on the IAQ was £3896, where a clinically significant difference was taken to be an 8-point improvement. The cost-effectiveness acceptability curve for the IAQ indicated that aripiprazole has a relatively high probability of being viewed as cost-effective for a range of plausible values attached to the incremental outcome difference. Additional costs of a clinically significant improvement on the CGI-Improvement and QLS were £575 and £835, respectively. These measures therefore support the view that aripiprazole is more cost-effective than SOC from a health and social care perspective for people with schizophrenia treated in the community.

Conclusion:

In the STAR study, use of aripiprazole in the management of patients with schizophrenia was cost-effective.

Key words::

• Aripiprazole
• Atypical antipsychotic
• Cost-effectiveness
• Schizophrenia
• STAR study

Transparency

Declaration of funding

The STAR study and this cost-effectiveness analysis were supported by Bristol-Myers Squibb Company and Otsuka Pharmaceutical Company Ltd.

Declaration of financial/other relationships

D.K. has disclosed that he has received research funding from Bristol-Myers Squibb. M.K. has disclosed that he has received research funding and consultancy fees from Bristol-Myers Squibb, Eli Lilly and Co. and AstraZeneca. J.-Y.L. has disclosed that he is an employee of Otsuka Pharmaceutical Europe Ltd. M.v.B. has disclosed that he is an employee of Bristol-Myers Squibb. At the time of submission, H.J.K. has disclosed that he was no longer an employee of Bristol-Myers Squibb. D.R. has disclosed that, during the writing of this article, she was a recipient of sponsorship for a post-doctoral research fellow at the Centre of Economic Mental Health, King’s College, University of London, UK from CAPES Ministry of Education of Brazil.

Acknowledgements

Editorial support was provided by Ogilvy 4D, funded by Bristol-Myers Squibb.