Cost-effectiveness of lurasidone vs quetiapine extended-release (XR) in patients with bipolar depression

Abstract

Objective:

Bipolar disorder imposes a high economic burden on patients and society. Lurasidone and quetiapine extended-release (XR) are atypical antipsychotic agents indicated for monotherapy treatment of bipolar depression. Lurasidone is also indicated as adjunctive therapy with lithium or valproate for depressive episodes associated with bipolar disorder. The objective of this analysis was to estimate the cost-effectiveness of lurasidone and quetiapine XR in patients with bipolar depression.

Methods:

A cost-effectiveness model was developed to compare lurasidone to quetiapine XR. The model was based on a US third-party payer perspective over a 3-month time horizon. The effectiveness measure in the model was the percentage of patients achieving remission (Montgomery-Åsberg Depression Rating Scale [MADRS] total score ≤12 by weeks 6–8). The comparison of remission rates was made through an adjusted indirect treatment comparison of lurasidone and quetiapine XR pivotal trials using placebo as the common comparator. Resource utilization for remission vs no remission was estimated from published expert panel data, and resource costs were obtained from a retrospective database study of bipolar I depression patients. Drug costs were estimated using the mean dose from clinical trials and wholesale acquisition costs.

Results:

Over the 3-month model time period, lurasidone and quetiapine XR patients, respectively, had similar mean numbers of emergency department visits (0.48 vs 0.50), inpatient days (2.1 vs 2.2), and office visits (9.3 vs 9.6). More lurasidone than quetiapine XR patients achieved remission (52.0% vs 43.2%) with slightly higher total costs ($4982 vs $4676), resulting in an incremental cost-effectiveness ratio of $3474 per remission. The probabilistic sensitivity analysis showed lurasidone had an 86% probability of being cost-effective compared to quetiapine XR at a willingness-to-pay threshold of $10,000 per remission.

Conclusions:

Lurasidone may be a cost-effective option when compared to quetiapine XR for the treatment of adults with bipolar depression.

Keywords::

• Cost-effectiveness
• Lurasidone
• Bipolar I depression
• Quetiapine XR

Transparency

Declaration of funding

This manuscript was sponsored by Sunovion Pharmaceuticals Inc.

Declaration of financial/other relationships

KR and AL are employees of Sunovion. KO, KM and MD are employees of Xcenda, a consulting firm that received funding from Sunovion to assist with this research. The authors are entirely responsible for the scientific content of the paper.

Acknowledgments

This manuscript was supported with copyediting assistance by Kylie Matthews, Xcenda. This manuscript was also reviewed by Daisy Ng-Mak, PhD, from Sunovion.