[PMH15] Cost-effectiveness analysis of long-acting risperidone (LA-RIS) vs haloperidol decanoate and oral olanzapine in the treatment of schizophrenia in Italy

[PMH15] Cost-effectiveness analysis of long-acting risperidone (LA-RIS) vs haloperidol decanoate and oral olanzapine in the treatment of schizophrenia in Italy

2003 Value in health

D'Ausilio, A. | Amaddeo, F. | Mencacci, C. | Munizza, C. | Miadi-Fargier, H. | Berto, P. | Volume: 6, Issue: 6, Pages: 693-694, analysis, cost-effectiveness analysis, Italy, Risperidone, Schizophrenia,

Compliance to treatment is a key success factor to reduce
hospitalisations in schizophrenic patients. Conventional
antipsychotics (e.g., haloperidol) are effective in reducing
positive symptoms of schizophrenia, and can cause
multiple side effects (extrapyramidal symptoms, tardive
dyskinesia). Atypical antipsychotics with daily oral
administration (risperidone, olanzapine, clozapine) show
improved efficacy and tolerability compared to conventional
neuroleptics. Conventional depots have been
shown to increase compliance and reduce the risk of
relapse over oral conventional treatments. Long-acting
risperidone (LA-RIS), administered intramuscularly once
every two weeks, is the first to combine the benefits of a
long-acting formulation with those of an atypical antipsychotic.
OBJECTIVE: To assess cost-effectiveness of
LA-RIS versus oral olanzapine (OLA) and haloperidol
decanoate (HAL-D) in recently diagnosed schizophrenic
patients in the perspective of the Italian National Health
care System (NHS). METHODS: A French decision tree
model was adapted to the Italian setting: outcome probabilities
and cost estimates were based on published
data, and supplemented with expert opinion. Only direct
medical costs were considered. For LA-RIS (not yet marketed
in Italy), 3 different price hypotheses were tested
(€100-125-150/injection q2weeks). Effectiveness measures
were relapse-free patients and patients maintained
on the same treatment for 2 years. RESULTS: LA-RIS was
found dominant versus HAL-D in all three hypotheses
tested. Versus OLA (10mg/day), LA-RIS costeffectiveness
ratios ranged from dominance to a
maximum of €17,544/2 years per incremental relapse-free
patient. Sensitivity analysis showed that results were
robust over a wide range of parameters tested, including
variation of the daily dose of OLA to account for current
medical practice in Italy according to the results of the
RODOS papers (13.5mg/day). CONCLUSIONS: The
model indicates that in recently diagnosed patients,
LA-RIS is cost-saving versus HAL-D and cost-saving/
cost-effective vs. OLA and should be preferred as a treatment
option over oral atypicals and conventional depots,
in the perspective of the Italian NHS.