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Cost-effectiveness analysis of switching antipsychotic medication to long-acting injectable risperidone in patients with schizophrenia : a 12- and 24-month follow-up from the e-STAR database in Spain.

Collaborators (305)

Villalobos Vega JC, Alonso Cuellar J, Alberca de Castro FJ, Morillo-Velarde Quintero C, Roman Martin JF, Tabares Dominguez P, Prados Ojeda JL, Sanz Cortes S, Mata Cala FI, Gutierrez Marin C, Moyano Castro L, Haza Duaso MA, Requena Albarracin J, Narbona Vergara G, Fernandez Benitez JA, Mayoral Cleries F, Garcia-Herrera Perez-Brian JM, Bordallo Aragon A, Rodriguez Navarro JC, Algarra Biedma JA, Bravo de Pedro R, Delgado Gonzalez JF, Jaren Lopez ME, Diaz Moreno H, Soto Lopez JA, Ojeda Rodriguez E, Martinez de Hoyos C, Pardilla Sacristan M, Molina Martin MD, Martin Ballesteros E, Sopelana Rodriguez PA, Fernandez Menendez L, Santos Rivas R, del Pino Cuadrado P, Correas Lauffer J, Rodriguez Solano JJ, Fernandez Martinez JM, Garcia Solano F, Garcia-Lamberde Rodriguez P, Romero Rodriguez JA, Rodriguez Cano T, Ducaju Fortacin M, Blanco Lobeiras JM, Piñeiro Sampedro JM, Pérez Bravo A, Fernández Pellicer A, Alonso López MD, Fraga Liste J, Riobo Fernández M, Casas Losada A, Vasquez-Noguerol Mendez R, Agra Romero S, Blanco Blanco JJ, Tortajada Bonaselt I, Garcia Mahia MC, Ferrer Gómez del Valle E, Quiroga Yañez P, Gelabert Camarasa M, Barbado Alonso JA, Florez Mendez G, Doce Feliz F, López Lamela MA, Vega Piñero M, Fuentes Alvarado P, López Gómez I, Fadon Martín P, Santos Gómez JL, García López A, Rodríguez-Jiménez R, Escudero Nafs A, Casas Barquero N, Fernández-Villamor Ortiz R, Velez Noguera JL, Ruiz Carrasco P, Martín Muñoz J, Masegoza Palma M, Marín Hortelano C, Sánchez Bonome L, Sánchez Sevilla J, Mongil San Juan JM, García Ramos JM, Vallejo Muñoz JL, Elorza Guisasola J, Santamaria Vazquez L, Campo Guerras F, Arrufat Nebot FJ, Baron Fernandez FJ, Palomo Nicolau AL, Catala Subirats R, Messays Kidias M, Fabregat Navarro V, Frades García B, Mejias del Rosal F, de Vicente Muñoz T, Año Ballester J, Malabia Lieb P, Delgado Martel A, Roca Bea E, Grau Joaquim I, Boatas Enjuanes F, Bañuelos Piñol M, Fontova i Carbonell E, Martín Muñoz R, Argila Giribets C, Albages Sans L, Serrano Blanco A, Arcega Felipe M, González Muñoz P, Pons Villanueva A, Bernardo Arroyo M, Coronas Borri R, Miret Fallada S, Celma Merola M, Parellada Rodon E, Pigem Palmes JR, Pérez Martínez E, Matarredona Catala J, Sandoval Coca A, Pascual Ferrandiz F, Ferrandiz Paya E, Iturri Caballero G, Franco Bonet A, Fluvia Figueras J, Moreno Pagador P, Medina Garibo M, Pérez Camo V, Sanz Carrillo C, Pelegrin Valero C, Caro Rebollo FJ, García Campayo J, Sala Ayma JM, Martínez Roig M, de Uña Mateos MA, Garcia Bertolin R, Martín García A, Jiménez Mazo F, Galvez Velasco JL, Santa Maria Pérez L, Jiménez Casado C, Mancheño Barba JJ, Conde Diaz M, Alcon Rubio JP, Soler Mandoli A, Uson Herrero A, Rodríguez Martínez A, Salgado Serrano P, Nieto Rodriguez E, Segui Montesinos J, Ferragud Macia J, Mateos Marcos A, Pérez-Fuster Soto JV, Verdaguer Dumont M, Parra Pagan J, Balanza Martínez V, Santiuste de Pablos M, Espinosa Delgado C, Martinez Quiles MD, Manzanera López FJ, Pozo Navarro P, Micol Torres A, Martinez Ingles FJ, Salmeron Arias-Camison JM, López Manzano JC, Villanueva Peña R, Petersen Guitarte G, Blasco Fontecilla H, Barjau Romero J, Sanz Gil R, Marín Lozano J, Donaire Adanez L, Zarranz Herrera-Oria I, Perez Jimenez J, Carrato Vaz F, Sanz García O, Contreras Anton C, Reixach Casula R, Natividad Hernandez MC, Teba Escabias F, Rodriguez Torresano J, Huidobro Perez-Villamil A, Estevez L, Aragües Figuero M, Muñoz de Morales A, Rodríguez Calvin JL, Delgado Criado M, Molina Rodríguez V, Balbo Ambrosolio E, Holgado Madera PM, Ponce Alfaro G, Rojas Vidal MM, Garcia Valtuille A, Ruiz O, Lucas Carbonero G, Echevarria Martinez de Bujo M, Maicas Mallen MJ, Santandreu Puigros J, Liñana Martorell A, Clar Forteza A, Rodríguez Arrebola E, Rodríguez de la Torre M, Anton Saiz CG, Bardolet i Casas C, Rodríguez Linde E, De Arce Cordon R, Padial Molina EM, Ruiz Carazo FJ, Muro Romero JJ, Vico Cano D, Soria Dorado M, Campos Velazquez S, Rodríguez Sánchez AJ, Ocio Leon S, Pachas Sánchez H, Henry Benitez M, Intxausti Zugarramurai A, Contreras MA, De la Varga González M, Barreiro Marin P, Gómez Robina F, Sanchez Garcia M, Otero Pérez FJ, Cubero Bros P, Carrillo Gómez A, de Dios Molina Martin J, Carrasco Perera JL, Averbach MC, Carrasco Perera JL, Goenaga Palancares E, Gallego de Dios MT, Fernandez Rojo C, Sánchez Iglesias S, Rubio Merino MI, Prieto Mestre N, Pérez Urdaniz A, Martínez Sánchez JM, Gordo Seco R, Franco Muñoz J, Mateos Agut M, Blanco Lozano ML, Martin Herguedas F, Torcal Pena A, Vicente Garcia J, Varona Martinez A, Sanz Granado O, Medina Fernández MA, Moran Canesco JM, Megia López PA, Franco Martin MA, Espina Barrio JA, Giner Ubago J, Roca Bennassar M, Olivares Díez JM, Hernandez Fleta JL, Porras Fortes F, Arango López C, Medina O, Figuera Alvarez D, Peña Roca JM, Rubio Valladolid G, Furquet Tavera JA, Garcia-Castrillon Sales JA, Batalla Llordes I, Anchuistegui Melgarejo C, Cañas de la Paz F, Vallés Callol V, Bousoño García M, Bobes García J, Vaz Leal FJ, Cáceres Corrales E, Sánchez Iglesias E, Carreiras Gómez MA, Garcia Serrano G, Román Chillarón EG, Samino Aguado FJ, Molina Castillo JJ, González González A, Gallardo Vazquez J, Bolivar Peralvarez M, Rios Diaz M, Ybarzabal Mesa M, Acosta Artiles FJ, Ajoy Chao M, Ybarzabal Mesa M, del Rosario Santana P, Garcia Escudero MA, Molla Berenguer M, Bonete Llacer JM, Juan Berna JA, Barragan Ortiz J, Tost Pardell L, Hernandez-Alvares de Sotomayor C, Cejas Mendez MR, Cabrera Garate R, Diaz Mugica B, Caballero Gonzalez M, Pujol Domingo J, Sáez Navarro C, Selva Vera G, Cuquerella MA, Lonjedo Monzo J, Cervera Boada P, Martin Pérez MF, Carrasco Parrado E, Yañez Sanchez JJ, Calvo Fernández J.

Author information

  • 1Department of Psychiatry, Hospital Meixoeiro, Complejo Hospitalario Universitario de Vigo, Vigo, Spain. jose.manuel.olivares@gmail.com

Abstract

BACKGROUND:

The availability of long-acting injectable risperidone may increase adherence to antipsychotic treatment and lead to improved clinical and economic outcomes for patients with schizophrenia.

OBJECTIVES:

To investigate the cost effectiveness of treatment with long-acting injectable risperidone compared with previous antipsychotic regimens in patients with schizophrenia enrolled in the electronic Schizophrenia Treatment Adherence Registry (e-STAR) in Spain.

METHODS:

e-STAR is an international, long-term, ongoing, observational study of schizophrenia patients who, during their routine course of clinical practice, are started on a new antipsychotic treatment. In e-STAR, data are collected at baseline, retrospectively over a minimum period of 12 months and up to a maximum of 24 months, and prospectively at 3-month intervals for 24 months after the start of a new antipsychotic drug. For the purpose of this study, patients who started treatment with long-acting injectable risperidone during their routine clinical management and were enrolled in the e-STAR study in Spain were eligible. The effectiveness of long-acting injectable risperidone compared with previous antipsychotic treatment, defined as the absence of hospitalizations or relapses, was assessed at 12 and 24 months of treatment. Acquisition costs of antipsychotic drug therapy were based on the official registered price. Drug prices from source were in euro, year 2005 values; hospital costs from source were in euro, year 2001 values, and were inflated to reflect 2005 costs. Complete follow-up data were available for 788 patients at 12 months after starting long-acting injectable risperidone and for 757 patients at 24 months.

RESULTS:

In terms of effectiveness, at 12 months after switching to long-acting injectable risperidone, there was a higher percentage of patients who did not require hospitalization (89.1%), did not relapse (85.4%) or neither required hospitalization nor relapsed (82.4%) as compared retrospectively with the same period for the previous treatment (67%, 47.8% and 59.8%, respectively). The corresponding figures at 24 months also favoured treatment with long-acting injectable risperidone (85.2% vs 60%, 88.5% vs 47.4% and 77% vs 53.6%, respectively). Treatment with long-acting injectable risperidone was associated with higher medication costs per month compared with previous antipsychotic medication after 12 (euro 405.80 vs euro 128.16) and 24 months (euro 407.33 vs euro 142.77) of follow-up. Cost effectiveness per month per patient was lower for risperidone than previous antipsychotic medication in the three patient scenarios: without hospitalization (euro 539.82 vs euro 982.13), without relapse (euro 519.67 vs euro 1242.03) and without hospitalization and without relapse (euro 597.22 vs euro 1059.39).

CONCLUSIONS:

Treatment with long-acting injectable risperidone compared with previous antipsychotic medications resulted in a higher number of patients not requiring hospitalization, not relapsing, and not requiring hospitalization and not showing relapse, resulting in risperidone being more cost effective per month per patient.It is important to note that real-world variations in adherence would automatically be controlled from within a randomized control trial, and hence, any evaluation of variations in adherence inevitably requires a real-world focus. On the basis of these findings, which were obtained in real-world clinical practice, long-acting injectable risperidone is predicted to be the dominant strategy because it results in effective symptom control and direct medical cost savings. However, because of limitations in methodology, any conclusions should, at this stage, be treated as tentative, and confirmation in more detailed follow-up studies is required. Cost-effectiveness comparisons based on experimental evaluations of relapse minimization strategies are also required. In order to avoid estimation biases in the future, a prospectively designed study is needed.

PMID:
18774869
[PubMed - indexed for MEDLINE]
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