Cost-effectiveness model comparing olanzapine and other oral atypical antipsychotics in the treatment of schizophrenia i
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BioMed Central
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Cost-effectiveness model comparing olanzapine and other oral atypical antipsychotics in the treatment of schizophrenia in the United States Nicolas M Furiak1, Haya Ascher-Svanum*2, Robert W Klein1, Lee J Smolen1, Anthony H Lawson2, Robert R Conley3 and Steven D Culler4 Address: 1Medical Decision Modeling Inc., Indianapolis, IN, USA, 2Eli Lilly and Company, Indianapolis, IN, USA, 3Lilly USA, LLC, Indianapolis, IN, USA and 4Emory University, Atlanta, GA, USA Email: Nicolas M Furiak - [email protected]; Haya Ascher-Svanum* - [email protected]; Robert W Klein - [email protected]; Lee J Smolen - [email protected]; Anthony H Lawson - [email protected]; Robert R Conley - [email protected]; Steven D Culler - [email protected] * Corresponding author
Published: 7 April 2009 Cost Effectiveness and Resource Allocation 2009, 7:4
doi:10.1186/1478-7547-7-4
Received: 27 June 2008 Accepted: 7 April 2009
This article is available from: http://www.resource-allocation.com/content/7/1/4 © 2009 Furiak et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Background: Schizophrenia is often a persistent and costly illness that requires continued treatment with antipsychotics. Differences among antipsychotics on efficacy, safety, tolerability, adherence, and cost have cost-effectiveness implications for treating schizophrenia. This study compares the cost-effectiveness of oral olanzapine, oral risperidone (at generic cost, primary comparator), quetiapine, ziprasidone, and aripiprazole in the treatment of patients with schizophrenia from the perspective of third-party payers in the U.S. health care system. Methods: A 1-year microsimulation economic decision model, with quarterly cycles, was developed to simulate the dynamic nature of usual care of schizophrenia patients who switch, continue, discontinue, and restart their medications. The model captures clinical and cost parameters including adherence levels, relapse with and without hospitalization, quality-adjusted life years (QALYs), treatment discontinuation by reason, treatment-emergent adverse events, suicide, health care resource utilization, and direct medical care costs. Published medical literature and a clinical expert panel were used to develop baseline model assumptions. Key model outcomes included mean annual total direct cost per treatment, cost per stable patient, and incremental costeffectiveness values per QALY gained. Results: The results of the microsimulation model indicated that olanzapine had the lowest mean annual direct health care cost ($8,544) followed by generic risperidone ($9,080). In addition, olanzapine resulted in more QALYs than risperidone (0.733 vs. 0.719). The base case and multiple sensitivity analyses found olanzapine to be the dominant choice in te
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