Background The Schizophrenia Trial of Aripiprazole (STAR) showed superior efficacy for aripiprazole compared with atypical antipsychotic standard-of-care (SOC) for the community treatment of schizophrenia1 based on the Investigator Assessment Questionnaire total score. Objective To determine the cost-effectiveness of aripiprazole compared with SOC medications from a health and social care system perspective. Methods Information on health and social care service use was collected using the Client Socio-demographic and Service Receipt Inventory (CSSRI). Unit costs attached to each service were used to calculate patients' healthcare and other costs. The primary outcome measure was Investigator's Assessment Questionnaire (IAQ) score; secondary measures included the Clinical Global Impression (CGI)-Improvement response and Quality of Life Scale (QLS). Incremental cost-effectiveness was measured over 26 weeks as the ratio of the difference in mean costs between aripiprazole and SOC (olanzapine, quetiapine and risperidone) to the difference in mean outcomes. Net benefit was used to plot the cost-effectiveness acceptability curve. Results The analysis sample (all randomised subjects who met the study inclusion criteria) included 282 individuals randomised to aripiprazole and 266 to SOC (olanzapine, n = 75; quetiapine, n = 110 and risperidone, n = 81). The additional mean cost of achieving a clinically significant difference on the IAQ was £3896, where a clinically significant difference was taken to be an 8-point improvement. The cost-effectiveness acceptability curve for the IAQ indicated that aripiprazole has a relatively high probability of being viewed as cost-effective for a range of plausible values attached to the incremental outcome difference. Additional costs of a clinically significant improvement on the CGI-Improvement and QLS were £575 and £835, respectively. These measures therefore support the view that aripiprazole is more cost-effective than SOC from a health and social care perspective for people with schizophrenia treated in the community. Conclusion In the STAR study, use of aripiprazole in the management of patients with schizophrenia was cost-effective
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