Economic evaluation of paliperidone palmitate once monthly for treating chronic schizophrenia patients in the United Arab Emirates

Abstract

Objective: Schizophrenia is one of the most debilitating diseases in the United Arab Emirates. Oral antipsychotics (OA) are commonly used in terms of pharmacotherapy; however, these treatments can be rendered ineffective by poor patient adherence. Paliperidone palmitate once monthly (PP1M) is a long acting antipsychotic which can offer an adherence advantage when compared to oral treatments. The study objective is to estimate the cost effectiveness of PP1M in the UAE setting.

Research design and methods: A 1-year validated decision-tree model was adapted to the UAE setting using published literature and expert opinion. Patients on PP1M were compared with or without oral supplementation to patients on any oral antipsychotic. Patient outcomes studied were incremental cost per quality adjusted life years gained, incremental cost per hospitalizations, relapses, and emergency room visits averted.

Results: After 1 year, patients on PP1M monotherapy when compared to oral antipsychotics had better outcomes (0.840 vs 0.811 QALYs; 31 relapse days averted as well as 9 and 24 percentage points of ER and hospitalizations averted, respectively), and better healthcare savings (AED 1405). PP1M economically dominated oral antipsychotics. The results were stable across a broad range of deterministic and probabilistic sensitivity analyses. PP1M plus oral antipsychotics could not be evaluated due to the absence of clinical data that would provide insight into the clinical value of combination therapy.

Conclusion: PP1M is estimated to save the UAE healthcare system money, while at the same time improving patient outcomes.

Keywords:

• GCC
• cost-effectiveness
• oral antipsychotics
• pharmacoeconomic analysis
• long-acting injectable
• middle east

Transparency

Declaration of funding

This study was funded by Johnson & Johnson Middle East FZ LLC with support from Janssen Pharmaceutica NV.

Declaration of financial/other relationships

S.N. and A.E.K are employees of Johnson & Johnson. A.S. is a Johnson & Johnson partner employee. A.E.K. is a Johnson & Johnson stockholder. A CMRO reviewer on this manuscript declares receiving speaker’s bureau from Janssen Pharmaceutica. Another CMRO reviewer declares currently working as a consultant with a manufacturer of an oral atypical antipsychotic (not Janssen). Other CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors would like to thank Janssen Pharmaceutica NV for financial assistance.