Heeg, B

Möller, HJ

Schmeding, A

Treur, MJ

Van Hout, BA

Elsevier - Publisher Connector 

PMH31 A PHARMACOECONOMIC ANALYSIS OF SCHIZOPHRENIC PATIENTS SWITCHING FROM BRANDED TO GENERIC RISPERIDONE INVOLVING A POSSIBLE COMPLIANCE LOSS 

PMH30
COST-EFFECTIVENESS OF QUETIAPINE IN COMBINATION
WITH LITHIUM OR DIVALPROEX: INTHE MAINTENANCE
TREATMENT OF BIPOLAR I DISORDER
Woodward TC1, Lazarus A2, Quon P1,Tafesse E2, Fleurence RL3
1United BioSource Corporation, Bethesda, MD, USA, 2AstraZeneca
Pharmaceuticals LP,Wilmington, DE, USA, 3United BioSource
Corporation Health Analytics Group, Bethesda, MD, USA
OBJECTIVE: Bipolar I disorder (BPD1), is a recurrent illness
that affects 1% of the US population (1) and severely impacts
both patient and caregiver quality of life. Although BPD1 con-
stitutes a large economic burden, few studies have investigated
the cost-effectiveness of maintenance treatment options (2).
METHODS: The cost-effectiveness of two years of maintenance
treatment with quetiapine (QTP) in combination with the tradi-
tional mood stabilizers [divalproex (DVP) or lithium (Li)], and
placebo (PBO) in combination with Li or DVP, was compared
using a Markov model, from a societal perspective. The model
simulates a cohort of 1000 stabilized BPD1 patients (i.e., suc-
cessful remission from prior acute mood episode) and estimates
the quarterly risk in three health states: euthymia, mania,
and depression. Efﬁcacy data were derived from Studies
D1447C00126 and D1447C00127, multicenter, randomized,
double-blind, parallel-group trials comparing QTP + Li/DVP
with PBO + Li/DVP for up to 2 years. Resource data were
obtained from published literature. Drug acquisition costs, hos-
pitalizations, and physician visits were among the direct costs
and indirect costs included absenteeism (2). Mortality rates
included suicide. Beneﬁts and costs were discounted at 3% and
the price reference year was 2007. The major endpoints included
costs per episode avoided and costs per quality-adjusted-life-
years (QALY). Probabilistic sensitivity analysis was conducted to
evaluate uncertainty in the results. RESULTS: Treatment with
QTP + Li/DVP was associated with reductions in acute mania
(45%), acute depression (41%), and related hospitalizations
(44%). In the base case analysis, QTP + Li/DVP dominated
PBO + Li/DVP. Probabilistic sensitivity analysis showed these
results to be robust. CONCLUSION: Quetiapine in combination
with lithium or divalproex is a cost-effective maintenance treat-
ment for patients with bipolar I disorder.
PMH31
A PHARMACOECONOMIC ANALYSIS OF SCHIZOPHRENIC
PATIENTS SWITCHING FROM BRANDEDTO GENERIC
RISPERIDONE INVOLVING A POSSIBLE COMPLIANCE LOSS
Treur MJ1, Heeg B1, Möller HJ2, Schmeding A3,Van Hout BA4
1Pharmerit Europe, Rotterdam, Zuid-Holland, Netherlands,
2Psychiatrische Klinik der Ludwig-Maximilians-Universität, München,
Germany, 3Janssen-Cilag GmbH, Neuss, Germany, 4Pharmerit Europe,
Rotterdam, Netherlands
OBJECTIVE: Patients might be reluctant to accept generic sub-
stitution, due to differences in colorants, shape, package design,
etc. This may result in poorer compliance, especially amongst
patients suffering from schizophrenia. Generic substitution for
schizophrenic patients decreases drug costs, possibly counter-
acted by more hospitalizations resulting from poorer compli-
ance. This study quantiﬁes the health-economic impact of
generic substitution of oral risperidone in Germany.
METHODS: An existing ﬁve-year discrete event simulation
(DES) model was adapted to compare patients staying on
branded risperidone (BR) with patients switching to generic ris-
peridone (GR). Differences between treatment arms include
compliance and medication costs. The compliance loss for
patients subject to generic substitution was varied between 0
and 10%. The generic price was assumed to be 40% of the
branded price (= €7.41). Incremental costs and effects were
recorded and analyzed. RESULTS: With 2.5%, 5.0%, 7.5%
and 10% difference in compliance, incremental effects of BR
over GR are 0.003, 0.006, 0.009 and 0.011 QALYs respec-
tively. Incremental costs are €871, €551, €231 and -€195.
Health beneﬁts are realized through improved symptom reduc-
tion resulting from better compliance. Improved symptom
reduction also decreases the number of hospitalizations, coun-
teracting the higher drug costs for BR. On average, each 2.5%-
point compliance difference causes a 0.003 QALY gain, while
incremental costs decrease with ~€355. Thus, for compliance
differences 6.5%, the model predicts BR to be cost-effective
compared to GR (using NICE threshold of 30,000
(~€42,000)). For compliance differences 8.5%, the model pre-
dicts BR to dominate GR. CONCLUSION: The DES model
predicts staying on BR may be cost-effective compared to
generic substitution if the latter causes a compliance loss
6.5%. For a compliance loss 8.5%, BR is predicted to
dominate GR. Better compliance involves improved symptom
reduction resulting in health beneﬁts and fewer hospitalizations.
The latter counteracts the higher medication costs associated
with BR.
PMH32
ACAMPROSATE INTREATMENT OF ALCOHOL
DEPENDENCE—ECONOMIC BENEFITS REVISITED
Erder MH1,Weycker D2, Oster G2
1Forest Research Institute, Jersey City, NJ, USA, 2Policy Analysis Inc.
(PAI), Brookline, MA, USA
OBJECTIVE: Acamprosate has been reported to be cost-effective
in maintaining abstinence in alcohol-dependent patients initiat-
ing psychosocial rehabilitation. This analysis updates earlier esti-
mates of the economic beneﬁts of such therapy. METHODS:
Estimated costs (2006 USA dollars) were compared over one year
between patients assumed to receive acamprosate as an adjunct
to psychosocial rehabilitation versus psychosocial rehabilitation
alone. Costs included acamprosate therapy, psychosocial reha-
bilitation services, and alcohol-related hospitalizations and
physician visits. Resource use estimates were obtained from a
prospective open-label cohort study. The cost of acamprosate
was based on average wholesale price, and an assumed standard
15% discount; all other unit costs were estimated using a large
USA health care claims database. RESULTS: The estimated cost
of acamprosate therapy over one year was $652 per patient
(mean duration of treatment, 180 days). Estimated costs of psy-
chosocial rehabilitation services were similar in the two groups.
Estimated costs of alcohol-related hospitalizations and physician
visits, however, were $1059 lower per patient among those
assumed to receive acamprosate. Accordingly, the estimated total
1-year cost of alcohol-related care was $407 lower per patient
among those assumed to receive acamprosate plus psychosocial
rehabilitation versus psychosocial rehabilitation alone. CON-
CLUSION: Overall costs of alcohol-related care may be sub-
stantially lower among alcohol-dependent patients receiving
acamprosate plus psychosocial rehabilitation in comparison with
psychosocial rehabilitation alone.
A118 Abstracts


file:///data/remote/core/dit/data/elsevier/pdf/b03/aHR0cDovL2FwaS5lbHNldmllci5jb20vY29udGVudC9hcnRpY2xlL3BpaS9zMTA5ODMwMTUxMDcwMzc5eA==.pdf

PMH31 A PHARMACOECONOMIC ANALYSIS OF SCHIZOPHRENIC PATIENTS SWITCHING FROM BRANDED TO GENERIC RISPERIDONE INVOLVING A POSSIBLE COMPLIANCE LOSS

Abstract

Similar works

Full text

Available Versions

Elsevier - Publisher Connector

Elsevier - Publisher Connector