Cost-Effectiveness of Long-Acting Injectable Paliperidone Palmitate Versus Haloperidol Decanoate in Maintenance Treatment of Schizophrenia
Robert A Rosenheck, Douglas L Leslie, Kyaw J Sint, Haiqun Lin, Yue Li, Joseph P McEvoy, Matthew J Byerly, Robert M Hamer, Marvin S Swartz, T Scott Stroup, Robert A Rosenheck, Douglas L Leslie, Kyaw J Sint, Haiqun Lin, Yue Li, Joseph P McEvoy, Matthew J Byerly, Robert M Hamer, Marvin S Swartz, T Scott Stroup
Abstract
Objective: This study assessed the relative cost-effectiveness of haloperidol decanoate (HD), a first-generation long-acting injectable (LAI) antipsychotic, and paliperidone palmitate (PP), a second-generation LAI antipsychotic.
Methods: A double-blind, randomized 18-month clinical trial conducted at 22 clinical research sites in the United States compared the cost-effectiveness of HD and PP among 311 adults with schizophrenia or schizoaffective disorder who had been clinically assessed as likely to benefit from an LAI antipsychotic. Patients were randomly assigned to monthly intramuscular injections of HD (25-200 mg) or PP (39-234 mg) for up to 24 months. Quality-adjusted life years (QALYs) were measured by a schizophrenia-specific algorithm based on the Positive and Negative Syndrome Scale and side-effect assessments; total health care costs were assessed from the perspective of the health system.
Results: Mixed-model analysis showed that PP was associated with .0297 greater QALYs over 18 months (p=.03) and with $2,100 more in average costs per quarter for inpatient and outpatient services and medication compared with HD (p<.001). Bootstrap analysis with 5,000 replications showed an incremental cost-effectiveness ratio for PP of $508,241 per QALY (95% confidence interval=$122,390-$1,582,711). Net health benefits analysis showed a .98 probability of greater cost-effectiveness for HD compared with PP at an estimated value of $150,000 per QALY and a .50 probability of greater cost-effectiveness at $500,000 per QALY.
Conclusions: HD was more cost-effective than PP, suggesting that PP's slightly greater benefits did not justify its markedly higher costs, which are likely to fall once the medication's patent expires.
Trial registration: ClinicalTrials.gov NCT01136772.
Figures
![Figure 1](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5048499/bin/nihms795641f1.jpg)
Figure 2
Quarterly total outpatient, inpatient and…
Figure 2
Quarterly total outpatient, inpatient and drug costs (p <.003>
Figure 3
Bootstrap analysis of the incremental…
Figure 3
Bootstrap analysis of the incremental cost effectiveness ratio (ICER): PP vs. HD
Figure 4
Cost Effectiveness Acceptability Curve (HD…
Figure 4
Cost Effectiveness Acceptability Curve (HD>PP)
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- Comparative Study
- Randomized Controlled Trial
- Adolescent
- Adult
- Aged
- Antipsychotic Agents / administration & dosage
- Antipsychotic Agents / economics
- Antipsychotic Agents / pharmacology*
- Cost-Benefit Analysis*
- Delayed-Action Preparations
- Double-Blind Method
- Female
- Haloperidol / administration & dosage
- Haloperidol / analogs & derivatives*
- Haloperidol / economics
- Haloperidol / pharmacology
- Humans
- Injections
- Male
- Middle Aged
- Outcome Assessment, Health Care*
- Paliperidone Palmitate / administration & dosage
- Paliperidone Palmitate / economics
- Paliperidone Palmitate / pharmacology*
- Patient Acceptance of Health Care / statistics & numerical data*
- Psychotic Disorders / drug therapy*
- Psychotic Disorders / economics
- Quality-Adjusted Life Years
- Schizophrenia / drug therapy*
- Schizophrenia / economics
- United States
- Young Adult
- Antipsychotic Agents
- Delayed-Action Preparations
- haloperidol decanoate
- Haloperidol
- Paliperidone Palmitate
- ClinicalTrials.gov/NCT01136772
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![Figure 2](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5048499/bin/nihms795641f2.jpg)
Figure 3
Bootstrap analysis of the incremental…
Figure 3
Bootstrap analysis of the incremental cost effectiveness ratio (ICER): PP vs. HD
Figure 4
Cost Effectiveness Acceptability Curve (HD…
Figure 4
Cost Effectiveness Acceptability Curve (HD>PP)
![Figure 3](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5048499/bin/nihms795641f3.jpg)
![Figure 4](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5048499/bin/nihms795641f4.jpg)
Source: PubMed