Cost-Effectiveness of Aripiprazole Tablets with Sensor versus Oral Atypical Antipsychotics for the Treatment of Schizophrenia Using a Patient-Level Microsimulation Modeling Approach

Figures & data

Figure 1 Model structure. The model represents a 1-month cycle. Patients may receive AS or oral AAPs in each cycle. Treatment decisions that apply to a cycle do not impact subsequent cycles. Patients who discontinue on AS in a given cycle may receive AS in the subsequent cycle. At the end of each cycle, clinical (hospitalization and PANSS and CGI-S score) and health economic outcomes (costs and utilities) are estimated for the cohort of patients.

Abbreviations: AAP, atypical antipsychotic; CGI-S, Clinical Global Impression – Severity scale; PANSS, Positive and Negative Syndrome Scale.

Table 1 PANSS Score at Baseline, 3 Months, and 6 Months of Treatment with AS

Clinical Parameter	Baseline^a	3-Month Follow-Up	6-Month Follow-Up
PDC, Mean (SD)	49.8 (36.60)	77.5 (31.80)	67.6 (32.70)
PANSS positive, Mean (SD)	18.4 (3.80)	16.3 (3.82)	15.3 (4.15)
PANSS negative, Mean (SD)	18.2 (3.76)	17.6 (3.79)	16.6 (3.95)
PANSS General psychopathology, Mean (SD)	35.2 (5.39)	33.0 (6.06)	31.2 (6.20)
CGI-S	3.8 (0.67)	3.4 (0.79)	3.2 (0.80)

Notes: ^aBaseline adherence for AS was assumed to be equivalent to that for patients on oral AAPs in the retrospective arm of the MONARCH trial. Adherence to AS for the rest of the analysis duration was based on 3- and 6-month data from the MONARCH trial, applying a logarithmic distribution to estimate the adherence during each month.

Abbreviations: AAP, atypical antipsychotic; AS, aripiprazole tablets with a sensor; CGI-S, Clinical Global Impression – Severity scale; PANSS, Positive and Negative Syndrome Scale; PDC, proportion of days covered; SD, standard deviation.

Table 2 Health Care Resource Utilization and Costs

	Resource Use	Cost Estimate (2021 USD)
Drug costs (WAC)
AS	–	$1650 per month^Citation22
Oral AAPs	–	$43.85 per month^a, ^Citation22
6-month psychiatric hospitalizations
AS	0.9%^Citation19	$4003.95 per day^Citation41
Oral AAP	19.8%^Citation19
Length of stay	7.0 days
Outpatient visits
Mild-to-moderately ill	16.0 visits^Citation42	$110.23 per encounter^Citation41
Moderate-to-severely ill	19.2 visits^Citation42
Laboratory testing
Mild-to-moderately ill	8.4 tests^Citation42	$353.40 per encounter^Citation42
Moderate-to-severely ill	9.0 tests^Citation42
Emergency/crisis center visit
Mild-to-moderately ill	0.38 visits^Citation42	$671.33 per encounter^Citation41
Moderate-to-severely ill	0.42 visits^Citation42
Indirect costs (per year)
Absence from work	4.4% (5.1 days)^Citation24	$51,480 per year^Citation25 (median US income)
Unemployment	35.3% (20.2 days)^Citation24
Informal care	60.9% (3.1 hours/day)^Citation24
Premature death	2.6%^Citation24
Reduction with improvement in PANSS	1.47^b, ^Citation24

Notes: The cost of oral AAPs is a weighted average based on the current market share for quetiapine, aripiprazole, risperidone, olanzapine, ziprasidone, and clozapine. ^aCost of oral AAPs based on the weighted average cost of generic oral AAPs (quetiapine, aripiprazole, risperidone, olanzapine, ziprasidone, clozapine) computed using market share data from March 2021 ^bReduction with improvement in PANSS based on the total healthcare costs for patients at baseline versus follow-up.

Abbreviations: AAP, atypical antipsychotic; AS, aripiprazole tablets with a sensor; PANSS, Positive and Negative Syndrome Scale; USD, United States Dollar; WAC, wholesale acquisition cost.

Table 3 Cost-Effectiveness of AS versus Generic Oral AAPs Estimated Using PANSS Scores and Treatment Status (Base Case)

	6 Months			12 Months
	Total Costs^a	Total QALYs	ICER^b	Total Costs^a	Total QALYs	ICER^b
Payer
AS	$9899	0.3293	–	$19,044	0.6680	–
Generic oral AAP	$8430	0.3194	–	$16,876	0.6383	–
Incremental difference	$1469	0.0099	$148,384	$2168	0.0298	$72,752
Societal
AS	$36,255	0.3293	–	$71,757	0.6680	–
Generic oral AAP	$47,042	0.3194	–	$94,101	0.6383	–
Incremental difference	($10,786)	0.0099	Dominant	($22,343)	0.0298	Dominant

Notes: ^aCosts reported in 2021 USD. ^b; results presented as cost per QALY.

Abbreviations: AAP, atypical antipsychotic; AS, aripiprazole tablets with sensor; ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life-years; USD, United States Dollar.

Figure 2 Uncertainties in the top five factors influencing ICER over 12 months from the payer perspective (deterministic sensitivity analysis).

Abbreviations: ICER, incremental cost-effectiveness ratio; PANSS, Positive and Negative Syndrome Scale; QALY, quality-adjusted life years.

Figure 3 Scatterplot evaluating the influence of uncertainties on the ICER over 12 months from the payer perspective (probabilistic sensitivity analysis).

Abbreviations: ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life-year; USD, United States Dollar; WTP, willingness-to-pay.

Table 4 Cost-Effectiveness of AS versus Generic Oral AAPs Using Durability of Treatment Effect Assumption (Scenario Analysis)

	6 Months			12 Months
	Total Costs^a	Total QALYs	ICER^b	Total Costs^a	Total QALYs	ICER^b
Payer
AS	$8079	0.3462	–	$14,784	0.6989	–
Generic oral AAP	$8430	0.3194	–	$16,876	0.6383	–
Incremental difference	($351)	0.0268	Dominant	($2092)	0.0606	Dominant
Societal
AS	$34,435	0.3462	–	$67,497	0.6989	–
Generic oral AAP	$45,368	0.3194	–	$90,761	0.6383	–
Incremental difference	($10,932)	0.0268	Dominant	($23,264)	0.0606	Dominant

Notes: ^aCosts reported in 2021 USD. ^b; results presented as cost per QALY.

Abbreviations: AAP, atypical antipsychotic; AS, aripiprazole tablets with sensor; ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life-years.

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