Cost-effectiveness of lurasidone vs aripiprazole among patients with schizophrenia who have previously failed on an atypical antipsychotic: an indirect comparison of outcomes from clinical trial data

Figures & data

Figure 1. Cost-effectiveness model structure.

Table 1. Discontinuation and hospital rates.

Input	Base case	SE	Source
Lurasidone
Total discontinuation (%)	0.534	0.041	Loebel 201325
Efficacy discontinuation (%)	0.143	0.044
Hospitalization (%)	0.057	0.026
Aripiprazole
Total discontinuation (%)	0.662	0.025	Chrzanowski et al.35
Efficacy discontinuation (%)	0.183	0.014
Hospitalization (%)	0.144	0.012
Clozapine (3rd-line)
Total discontinuation (%)	0.379	0.061	McEvoy 200628
Efficacy discontinuation (%)	0.069	0.030
Hospitalization (%)	0.052	0.010

Table 2. Cardiometabolic parameters.

Input	Base case	SE	Source
Lurasidone - Weight Change (kg/year)	0.70	1.64	Loebel 201325
Lurasidone - Cholesterol Change (mg/dl/year)	0.0	1.6
Lurasidone - Diabetes Relative Risk	1.00	0.04	Assumption
Aripiprazole - Weight Change (kg/year)	2.06	1.64	Chrzanowski et al.35
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	McEvoy 200628
Clozapine - Cholesterol Change (mg/dl/year)	3.9	3.1
Clozapine - Diabetes Relative Risk	1.57	0.15	Leslie and Rosenheck38

Table 3. Annual treatment costs and resource utilization.

Input	Base case	SE	Source
Annual treatment costs
Lurasidone	$9,116	$456*	Loebel 201325; Red Book43
Aripiprazole	$9,748	$487*	Chrzanowski et al.35; Red Book43
Clozapine	$1,986	$99*	McEvoy 200628; Red Book43
Resource utilization
No relapse cost	$11,535	$481	Ascher-Svanum et al.44; BLS27
Relapse (no hospitalization) cost	$13,358	$962	Ascher-Svanum et al.44; BLS27
Relapse (with hospitalization) cost	$44,223	$4326	Ascher-Svanum et al.44; BLS27
Diabetes management	$7,900	$790**	ADA45; BLS27
Cardiovascular event cost	$40,637	$4064**	O’Sullivan et al.42; BLS27

*Assumed SE is 5% of the mean.

**Assumed SE is 10% of the mean.

Figure 2. ICER per hospitalization avoided (a) and relapse avoided (b).

Table 4. Discounted clinical outcomes and costs for atypical antipsychotics.

	Lurasidone	Aripiprazole
Outcomes (per patient)
Relapses	0.4423	0.4777
Hospitalizations	0.2453	0.3687
Diabetes	0.0729	0.0736
CVD Events	0.0373	0.0378
Costs (per patient)
Pharmacy	$18,076	$16,476
Mental Health	$64,099	$69,622
Diabetes	$2,787	$2,864
Cardiovascular	$1,517	$1,537
Total	$86,480	$90,500

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

Figure 4. Cost-effectiveness acceptability curve: hospitalization avoided (a) and relapse avoided (b).

Table 5. Probabilistic sensitivity analysis results.

Drug	Cost (95% CI)	Hospitalizations (95% CI)	Relapses (95% CI)
Lurasidone	$86,529 ($81,423, $91,719)	0.2456 (0.2198, 0.2719)	0.4460 (0.3738, 0.5208)
Aripiprazole	$90,550 ($85,190, $96,054)	0.3694 (0.3495, 0.3902)	0.4787 (0.4254, 0.5341)

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