Modeling the budget impact of long-acting injectable paliperidone palmitate in the treatment of schizophrenia in Japan

Figures & data

Table 1 Treated patients with schizophrenia

Parameter	Value, n	Source
Inhabitants of Japan	127,298,000	Statistics Japan^Citation26
Number of treated people with diagnosed schizophrenia	713,000 (0.56% of total population)	Ministry of Health, Labor and Welfare^Citation27

Table 2 Prices of antipsychotics in the Japanese market (as of April 2014)

Drug	Dosage specification	Price per dose (yen)	Dosage frequency
Paliperidone palmitate (LAI) (Xeplion^®)	1 syringe, 25 mg	18,958	Once a month
	1 syringe, 50 mg	30,391
	1 syringe, 75 mg	40,051
	1 syringe, 100 mg	48,716
	1 syringe, 150 mg	64,202
Risperidone (LAI) (Risperdal Consta^®)	1 syringe, 25 mg	24,192	Every 14 days
	1 syringe, 37.5 mg	31,883
	1 syringe, 50 mg	38,780
Risperidone (oral) (Risperdal^®)	1 Tablet, 0.5 mg	17.00	Twice a day
	1 Tablet, 1.0 mg	31.90
	1 Tablet, 2.0 mg	56.60
	1 Tablet, 3.0 mg	79.30
Generic risperidone (oral; cheapest price)	1 Tablet, 0.5 mg	9.60	Twice a day
	1 Tablet, 1.0 mg	9.90
	1 Tablet, 2.0 mg	15.70
	1 Tablet, 3.0 mg	20.50
Generic risperidone (oral; weighted average price)	1 Tablet, 0.5 mg	10.30	Twice a day
	1 Tablet, 1.0 mg	14.50
	1 Tablet, 2.0 mg	24.60
	1 Tablet, 3.0 mg	40.80
Olanzapine (oral) (Zyprexa^®)	1 Tablet, 2.5 mg	138.30	Once daily
	1 Tablet, 5 mg	258.50
	1 Tablet, 10 mg	489.90
Aripiprazole (Abilify^®)	1 Tablet, 3 mg	97.10	Once or twice a day
	1 Tablet, 6 mg	184.40
	1 Tablet, 12 mg	350.40
	1 Tablet, 24 mg	665.90
Quetiapine (oral) (Seroquel^®)	1 Tablet, 25 mg	41.50	Twice or three times a day
	1 Tablet, 100 mg	143.80
	1 Tablet, 200 mg	268.70
Blonanserin (Lonasen^®)	1 Tablet, 2 mg	78.80	Twice a day
	1 Tablet, 4 mg	147.80
	1 Tablet, 8 mg	276.80
Haloperidol (Serenace^®)	1 Tablet, 0.75 mg	7.80	Once, twice, or three times a day
	1 Tablet, 1 mg	7.80
	1 Tablet, 1.5 mg	9.40
	1 Tablet, 3 mg	10.40

Abbreviation: LAI, long-acting injectable.

Table 3 Dosage distribution of paliperidone palmitate

Dosage	Paliperidone palmitate (Xeplion^®)
25 mg	3.2%
50 mg	11.4%
75 mg	18.3%
100 mg	41.8%
150 mg	25.3%

Table 4 Future market shares and prices (based on defined daily dose)

	Before paliperidone palmitate (t =0)		After paliperidone palmitate (t= 1)		Post-paliperidone palmitate (t =2)		Post-paliperidone palmitate (t =3)
	Market share (%)	Daily price (yen)	Market share (%)	Daily price (yen)	Market share (%)	Daily price (yen)	Market share (%)	Daily price (yen)
Paliperidone palmitate (LAI) (Xeplion^®)	0.03	1,411.82	0.19	1,430.39	0.35	1,430.39	0.74	1,430.39
Risperidone (LAI) (Risperdal Consta^®)	0.64	2,214.07	0.45	2,277.36	0.35	2,277.36	0.27	2,277.36
Risperidone (oral) (Risperdal^®)	12.44	149.40	10.92	135.90	9.51	135.90	8.70	122.30
Risperidone (oral) GE	10.68	76.50	11.74	65.30	12.73	65.30	13.04	45.80
Olanzapine (oral) (Zyprexa^®)	14.82	476.80	15.30	489.90	15.53	489.90	12.32	411.50
Olanzapine (oral) GE	0.00	0.00	0.00	0.00	0.00	258.70	3.46	219.90
Aripiprazole (Abilify^®)	13.76	435.10	15.35	447.50	14.84	447.50	11.43	375.90
Aripiprazole GE	0.00	0.00	0.00	0.00	1.55	236.30	6.07	200.90
Quetiapine (oral) (Seroquel^®)	13.77	621.80	10.88	537.40	8.49	537.40	7.72	456.80
Quetiapine (oral) GE	4.93	335.80	8.01	233.80	10.62	233.80	11.58	163.80
Blonanserin (Lonasen^®)	3.80	412.80	3.97	424.60	4.14	424.60	4.3	424.60
Conventionals	25.13	20.0	23.19	19.8	21.89	19.8	20.37	19.6

Note: Daily price is based on per patient.

Abbreviations: GE, generic drug; LAI, long-acting injectable; t, time (year).

Table 5 Rehospitalization rates per annum

Drug	Rehospitalization rates (%)	Source
Paliperidone palmitate (Xeplion^®)	14.40	Gaebel et al^Citation14 and assumption
Risperidone (LAI) (Risperdal Consta^®)	14.40	Gaebel et al^Citation14
Risperidone (oral) (Risperdal^®)	27.60	National Collaborating Centre for Mental Health. Schizophrenia^Citation36
Blonanserin (Lonasen^®)	27.60	Kishi et al^Citation39
Olanzapine (oral) (Zyprexa^®)	20.00	National Collaborating Centre for Mental Health. Schizophrenia^Citation36
Aripiprazole (Abilify^®)	27.40	National Collaborating Centre for Mental Health. Schizophrenia^Citation36
Quetiapin (oral) (Seroquel^®)	33.20	Leucht et al^Citation37
Conventionals	33.20	National Collaborating Centre for Mental Health. Schizophrenia^Citation36

Abbreviation: LAI, long-acting injectable.

Table 6 Costs per annum of schizophrenia with and without PLAI (million yen)

	Drug costs	Nondrug costs	Total costs
Without PLAI	69,657.62	640,880.51	710,538.12
With PLAI after 1 year	72,233.35	637,580.98	709,814.33
With PLAI after 2 years	71,150.38	635,579.72	706,730.10
With PLAI after 3 years	58,481.23	632,566.69	691,047.92
With PLAI (average cost per year)	67,288.32	635,242.47	702,530.79
Average cost difference with/without PLAI	−2,369.29	−5,638.04	−8,007.34

Abbreviation: PLAI, paliperidone long-acting injectable.

Table 7 Deterministic sensitivity analysis of cost per hospitalization

Cost per hospitalization (JPY)	Total cost differences (million JPY)
2,150,000	−6,217.07
3,150,337	−8,007.34
4,150,000	−9,796.40

Abbreviation: JPY, Japanese yen.

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