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

Figures & data

Figure 1. Cost-effectiveness model structure. XR, extended-release.

Table 1. Mean rates of remission for lurasidone, quetiapine XR, and placebo in the short-term treatment of bipolar disorder.

Input	Mean remission rate	SE for remission rate	Source
Lurasidone 20–120 mg (pooled) remission rate	52.0%	4.8%	Indirect treatment comparison based on MADRS remission rates in references 20 and 21
Quetiapine XR 300 mg remission rate	43.2%	4.2%
Placebo (pooled) remission rate	31.4%	3.7%

MADRS, Montgomery-Åsberg Depression Rating Scale; SE, standard error; XR, extended-release.

Table 2. Resource utilization parameters (per 6 week time period).

Input	Remission (recovery state)		No remission (acute depressive state)		Source
	Mean	SE	Mean	SE
ED visits (%)	5.0%	0.50%	20.0%	2.00%	19
ED visits (#)	1.5	0.2	1.5	0.2	19
Inpatient hospitalization (%)	2.5%	0.25%	15.0%	1.50%	19
Inpatient hospitalization (LOS)	7.0	0.7	9.0	0.9	19
Inpatient physician visits (#/day)	1.0	0.1	1.0	0.1	19
Outpatient post-hospital visits (#)	4.0	0.4	3.0	0.3	19
Outpatient physician visits (#)	2.0	0.2	6.0	0.6	19

ED, emergency department; LOS, length of stay; SE, standard error.

Table 3. Cost parameters.

Input	Mean	SE	Source
Lurasidone monotherapy analysis cost/month	$700	$35	23
Quetiapine XR 300 mg cost/month	$547	$27	23
Placebo	$0	$0	Assumption
ED cost/visit	$358	$18	24
Inpatient hospital cost/day	$1025	$51	24
Physician visit cost (post-hospitalization)	$93	$5	24
Physician visit cost (routine)	$82	$4	24

ED, emergency department; SE, standard error; XR, extended-release.

Table 4. Cost-effectiveness results.

Comparator	Cost	Remission	Δ Cost	Δ Remission	ICER
Quetiapine XR	$4676	43.2%	–	–	Reference
Lurasidone	$4982	52.0%	$306	8.8%	$3474

ICER, incremental cost-effectiveness ratio; XR, extended-release.

Table 5. One-way sensitivity analysis results.

Parameters	Parameter values		ICERs*
	Low	High	Low	High
Quetiapine XR remission rate	35.0%	51.4%	$1192	$71,900
Lurasidone remission rate	42.6%	61.4%	−$68,161†	$1082
Lurasidone cost/month	$632	$769	$1359	$5589
Quetiapine XR cost/month	$493	$601	$5094	$1854

ICER, incremental cost-effectiveness ratio; XR, extended-release.

*The base case ICER was $3474.

†Quetiapine XR dominant.

Figure 2. Cost-effectiveness acceptability curve. XR, extended-release; WTP, willingness-to-pay.