Economic and clinical comparison of atypical depot antipsychotic drugs for treatment of chronic schizophrenia in the Czech Republic

Figures & data

Figure 1. Decision tree used for the economic analysis.

Table 1. Clinical management of schizophrenia and sources of information.

Drug	Treatment	Regimen	Data source
PP-LAI	Treatment initiation for relapse requiring hospitalization	150 mg week 1, 100 mg week 2, then 82.8 mg every 4 weeks maintenance	Xeplion® product summary15, Hough et al.17
	Relapse not requiring hospitalization	84.9 mg every 4 weeks	Average of Gopal et al.18, Pandina et al.19, Hough et al.20, Nasrallah et al.21, Pandina et al.22
	Maintenance	69.3 mg every 4 weeks	Gopal et al.23, Fleischhacker et al.24
		Adjunct: 6.8 mg oral risperidone for 30.5 days	Gopal et al.23
RIS-LAI	Treatment initiation for relapse requiring hospitalization	50 mg every 2 weeks	Maintenance dose pro-rated as per PP-LAI (equals the maximum dose in product summary)25
	Relapse not requiring hospitalization	50 mg every 2 weeks	Maintenance dose pro-rated as per PP-LAI (also equals the maximum dose in Risperdal Consta® product summary)25
	Maintenance	40.3 mg every 2 weeks	Average of Fleischhacker et al.24, Kissling et al.26, Lee et al.27, Lindenmayer et al.28, Olivares et al.29
		Adjunct: oral 3.2 mg/day for 43 days	Möller et al.30
OLZ-LAI	Treatment initiation for relapse requiring hospitalization	300 mg every 2 weeks ×3, then 473 mg every 4 weeks	Zypadhera® product summary16, Lauriello et al.31
	Relapse not requiring hospitalization	473 mg every 4 weeks	Lauriello et al.31
	Maintenance	432 mg every 4 weeks	Kane et al.32
		Adjunct: oral 10.8 mg/day for 31 days	Ascher-Svanum et al.33
clozapine	Two failed LAIs	500 mg daily	Average dose in 9 trials reported by Chakos et al.34
	Incomplete response	750 mg daily	Average of dose range in European Medicines Agency recommendations35

LAI, long acting antipsychotic; OLZ-LAI, olanzapine (Zypadhera®); PP, paliperidone palmitate (Xeplion®), RIS, risperidone (Risperdal Consta®).

Table 2. Clinical rates used as inputs for calculations in the model.

Drug	Rate	Value input (probability)	Source
PP-LAI	Stable disease	0.803	Calculation: 1 – (Relapses + hospitalizations)
	Relapse not requiring hospitalization	0.059	Calculation: Average hospitalization rate from Gopal et al.23 and Hough et al.17× relapse:hospitalization ratio from Ascher-Svanum et al.36
	Relapse requiring hospitalization	0.138	Gopal et al.23, Hough et al.17
	Re-hospitalization	0.108	Nicholl et al.37
	Adherence	0.872	Olivares et al.38 adjusted via Mehnert and Diels39
RIS-LAI	Stable disease	0.763	Calculation: 1 – (Relapses + hospitalizations)
	Relapse not requiring hospitalization	0.071	Olivares et al.38
	Relapse requiring hospitalization	0.166	Olivares et al.38
	Re-hospitalization	0.131	Nicholl et al.37
	Adherence	0.823	Olivares et al.38
OLZ-LAI	Stable disease	0.793	Kane et al.32
	Relapse not requiring hospitalization	0.062	Calculation: 1 – (Stable + hospitalizations)
	Relapse requiring hospitalization	0.145	Kane et al.32
	Re-hospitalization	0.114	Nicholl et al.37
	Adherence	0.803	Ascher-Svanum et al.36

Table 3. Units costs for resources.

Resource	Item	Unit	Cost/unit	Source
Drugs	Clozapine tablets	mg	€0.005/mg	SÚKL45
	Olanzapine tablets	mg	€0.148/mg	SÚKL45
	Olanzapine LAI	mg	€0.945/mg	SÚKL45
	Paliperidone LAI	mg	€4.440/mg	SÚKL45
	Risperidone tablets	mg	€0.125/mg	SÚKL45
	Risperidone LAI	mg	€4.977/mg	SÚKL45
Hospital care	Emergency room	1 visit	€50.33	UZIS46,47
	Psychiatric ICU	1 day	€167.50	Expert opinion
	Acute psychiatric ward	1 day	€43.35	UZIS46,47
	Medical ward	1 day	€39.41	UZIS46,47
	ICU	1 day	€788.25	UZIS46,47
Medical care	Psychiatrist (outpatient)	1 visit	€14.27	Act 411/201148
	Psychiatric nurse	per month	€301.74	Act 411/201148
	Staff nurse	1 visit	€6.15	Act 411/201148
	Psychologist	1 visit	€10.35	Act 411/201148

ICU, intensive care unit; LAI, long acting injectable.

Table 4. Pharmacoeconomic results.

Type	Outcome	PP-LAI	RIS-LAI	OLZ-LAI
Clinical	Stable days	329.5	324.7	324.9
	ER visits*	0.127	0.134	0.141
	Hospitalizations*	0.252	0.298	0.289
	QALYs	0.817	0.809	0.811
Economic	Cost	€5377	€6118	€6537

LAI, long acting antipsychotic; OLZ-LAI, olanzapine (Zypadhera®); PP, paliperidone palmitate (Xeplion®), QALY, quality-adjusted life year; RIS, risperidone (Risperdal Consta®).

*Proportions of patients experiencing the outcome.

Figure 2. Incremental cost-utility ratio plotting cost in euros on the y-axis against quality adjusted life-years on the x-axis of PP-LAI vs (a) OLZ-LAI, and (b) RIS-LAI—results from a probability sensitivity analysis with 10,000 iterations.

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