Long-term cost-effectiveness of atypical antipsychotics in the treatment of adults with schizophrenia in the US

Figures & data

Figure 1 Cost-effectiveness model structure.

Table 1 Discontinuation and hospitalization rates

Input	Base case	SE	Reference
Lurasidone
Total discontinuation (%)	0.534	0.041	^Citation24
Efficacy discontinuation (%)	0.143	0.044
Hospitalization (%)	0.057	0.026
Olanzapine
Total discontinuation (%)	0.491	0.025	^Citation4
Efficacy discontinuation (%)	0.099	0.014
Hospitalization (%)	0.078	0.012
Risperidone
Total discontinuation (%)	0.588	0.025	^Citation4
Efficacy discontinuation (%)	0.192	0.014
Hospitalization (%)	0.105	0.014
Quetiapine
Total discontinuation (%)	0.678	0.025	^Citation4
Efficacy discontinuation (%)	0.196	0.018
Hospitalization (%)	0.140	0.016
Ziprasidone
Total discontinuation (%)	0.649	0.034	^Citation4
Efficacy discontinuation (%)	0.168	0.023
Hospitalization (%)	0.122	0.020
Aripiprazole
Total discontinuation (%)	0.662	0.025	^Citation25
Efficacy discontinuation (%)	0.183	0.014
Hospitalization (%)	0.144	0.012
Clozapine
Total discontinuation (%)	0.379	0.061	^Citation27
Efficacy discontinuation (%)	0.069	0.030
Hospitalization (%)	0.052	0.010

Abbreviation: SE, standard error.

Table 2 Cardiometabolic parameters

Input	Base case	SE	Reference
Lurasidone, weight change (kg/year)	0.70	1.64	^Citation24
Lurasidone, cholesterol change (mg/dL/year)	0.0	1.6
Lurasidone, diabetes relative risk	1.00	0.04	Assumption
Olanzapine, weight change (kg/year)	10.91	1.64	^Citation4
Olanzapine, cholesterol change (mg/dL/year)	6.3	1.6
Olanzapine, diabetes relative risk	1.15	0.04	^Citation29
Risperidone, weight change (kg/year)	2.18	1.64	^Citation4
Risperidone, cholesterol change (mg/dL/year)	−0.9	1.6
Risperidone, diabetes relative risk	1.01	0.04	^Citation29
Quetiapine, weight change (kg/year)	2.73	1.09	^Citation4
Quetiapine, cholesterol change (mg/dL/year)	4.4	1.6
Quetiapine, diabetes relative risk	1.20	0.11	^Citation29
Ziprasidone, weight change (kg/year)	−1.64	1.64	^Citation4
Ziprasidone, cholesterol change (mg/dL/year)	−5.5	2.1
Ziprasidone, diabetes relative risk	1.00	0.04	Assumption
Aripiprazole, weight change (kg/year)	2.06	1.64	^Citation25
Aripiprazole, cholesterol change (mg/dL/year)	−1.00	1.6
Aripiprazole, diabetes relative risk	1.00	0.04	Assumption
Clozapine, weight change (kg/year)	2.73	2.73	^Citation27
Clozapine, cholesterol change (mg/dL/year)	3.9	3.1
Clozapine, diabetes relative risk	1.57	0.15	^Citation29

Abbreviation: SE, standard error.

Table 3 Annual treatment costs and resource utilization

Input	Base case	SE	Reference
Annual treatment costs
Lurasidone	$9,116	$456	^Citation24, ^Citation33
Olanzapine	$7,862	$393	^Citation4, ^Citation33
Risperidone	$2,239	$112	^Citation4, ^Citation33
Quetiapine	$9,853	$493	^Citation4, ^Citation33
Ziprasidone	$3,514	$176	^Citation4, ^Citation33
Aripiprazole	$9,748	$487	^Citation25, ^Citation33
Clozapine	$1,986	$99	^Citation27, ^Citation33
Resource utilization
No relapse cost	$11,535	$481	^Citation34, ^Citation19
Relapse (no hospitalization) cost	$13,358	$962	^Citation34, ^Citation19
Relapse (with hospitalization) cost	$44,223	$4,326	^Citation34, ^Citation19
Diabetes management	$7,900	$790	^Citation35, ^Citation19
Cardiovascular event cost	$40,637	$4,064	^Citation32, ^Citation19

Note: All amounts shown in US dollars.

Abbreviation: SE, standard error.

Table 4 Discounted clinical outcomes and costs for atypical antipsychotics

	Lurasidone	Olanzapine	Risperidone	Quetiapine XR	Ziprasidone	Aripiprazole
Outcomes (per patient)
Hospitalizations	0.3953	0.4182	0.4567	0.4857	0.4705	0.4907
Diabetes	0.0591	0.0586	0.0591	0.0586	0.0598	0.0597
Cardiovascular disease events	0.0373	0.0397	0.0376	0.0377	0.0372	0.0376
Costs (per patient)
Pharmacy	$29,947	$29,159	$25,519	$29,058	$26,483	$29,121
Mental health	$71,142	$72,037	$73,960	$75,232	$74,513	$75,431
Diabetes	$2,236	$2,289	$2,244	$2,292	$2,260	$2,260
Cardiovascular	$1,514	$1,611	$1,528	$1,532	$1,512	$1,529
Total costs	$104,840	$105,096	$103,251	$108,115	$104,768	$108,341

Note: All amounts shown in US dollars.

Abbreviation: XR, extended-release.

Figure 2 ICER per relapse-related hospitalization avoided.

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

Figure 3 One-way sensitivity analysis results (tornado diagram).

Note: Amounts shown are in US dollars.

Figure 4 Cost-effectiveness acceptability curve.*

Note: *Ziprasidone, quetiapine XR, and aripiprazole all had 0% probability of being cost-effective across the tested range of WTP thresholds. Amounts shown are in US dollars.
Abbreviations: WTP, willingness to pay; XR, extended-release.

Table 5 Probabilistic sensitivity analysis results

Rank	Drug	Cost (95% CI)	Hospitalizations (95% CI)	Net monetary benefita (95% CI)
1	Lurasidone	$104,877	0.3955	−$124,653
		($99,656, $110,021)	(0.3706, 0.4225)	(−$130,282, −$118,965)
2	Olanzapine	$105,116	0.4183	−$126,031
		($99,731, $110,306)	(0.4017, 0.4368)	(−$131,498, −$120,405)
3	Risperidone	$103,267	0.4568	−$126,107
		($97,854, $108,789)	(0.4378, 0.4761)	(−$131,915, −$120,352)
4	Ziprasidone	$104,814	0.4712	−$128,372
		($99,423, $110,471)	(0.4488, 0.4959)	(−$134,243, −$122,405)
5	Quetiapine XR	$108,56	0.4857	−$132,442
		($102,197, $113,781)	(0.4662, 0.5077)	(−$138,469, −$126,166)
6	Aripiprazole	$108,371	0.4908	−$132,913
		($102,537, $114,002)	(0.4720, 0.5114)	(−$138,886, −$126,659)

Note:

a Net monetary benefit at a willingness-to-pay threshold of $50,000 per hospitalization avoided. Amounts shown are in US dollars.

Abbreviations: CI, confidence interval; XR, extended-release.

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