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Psych Congress  

Long-term Costs and Outcomes of Patients with Schizophrenia who have Previously Failed an Atypical Antipsychotic

Krithika Rajagopalan, PhD; Mariam Hassan, PhD; Ken O'Day, PhD, MPA; Kellie Meyer, PharmD, MPH; Fred Grossman, DO
Sunovion Pharmaceuticals Inc.

OBJECTIVE: To estimate long-term costs and outcomes of lurasidone and aripiprazole among adults with schizophrenia in the US that previously failed ≥1 atypical antipsychotic (AAP) (olanzapine, risperidone, quetiapine, or ziprasidone). METHODS: A 5-year Markov cohort model was developed to compare lurasidone and aripiprazole, including total discontinuations, relapse rates, and hospitalization rates as effectiveness measures. Cost inputs included pharmacy, mental health, and medical costs associated with cardiometabolic (CM) risks (diabetes and cardiovascular (CV) events). Effectiveness inputs were derived from an indirect comparison of aripiprazole (Chrzanowski 2006) and lurasidone (Loebel 2010) using common comparators from CATIE. CM risks were derived from claims data analysis for diabetes, weight change and CV events, and Framingham BMI risk-equation. Cost inputs were derived from published sources and Redbook. Costs and outcomes were discounted at 3% and tested with sensitivity analyses. RESULTS: Over a 5-year period, total predicted costs for lurasidone and aripiprazole patients were $85,433 and $86,638, respectively. During this period, the number of relapses per patient, hospitalizations per patient, diabetes rates, and CV events per 1,000 patients, respectively, were estimated to be lower for lurasidone (0.478, 0.268, 8.45%, and 40.9) than aripiprazole (0.514, 0.396, 8.53%, and 41.5). The results were sensitive to lurasidone discontinuation and hospitalization rates. Sensitivity analysis estimated lurasidone had an 82% probability of being less costly than aripiprazole. CONCLUSIONS: Using modeled results, lurasidone had fewer relapses and hospitalizations with a lower incidence of diabetes and CV events. Furthermore, when switching from another atypical antipsychotic, lurasidone may be less costly than aripiprazole among adults with schizophrenia.

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