RESUMEN
AIM: To estimate the budget impact (BI) of introducing aripiprazole once-monthly 400 mg/300 mg (AOM 400) in the maintenance monotherapy treatment of bipolar I disorder versus long-acting injectables, oral antipsychotics and best supportive care. METHODS: A BI model was developed from a US-payer perspective using treatment-related, hospitalization and adverse event management cost estimates for a hypothetical 1,000,000-member health plan over a 5-year period. RESULTS: Market share of AOM 400 was predicted to increase from 0.6% in Year 1 (current scenario) to 1.3% in Year 5 (predicted scenario), with predicted increases for paliperidone palmitate, asenapine and cariprazine. Treatment-related costs explained the BI increase, while adverse event and hospitalization costs were reduced. The per member per month incremental cost ranged from US$0.06 to US$0.26 in Years 1-5. The largest increases were predicted for paliperidone palmitate. CONCLUSION: As market shares of atypical antipsychotics are predicted to increase, payers may wish to re-evaluate their use.
Asunto(s)
Antipsicóticos/economía , Aripiprazol/economía , Trastorno Bipolar/economía , Adulto , Antipsicóticos/administración & dosificación , Antipsicóticos/efectos adversos , Aripiprazol/administración & dosificación , Aripiprazol/efectos adversos , Trastorno Bipolar/tratamiento farmacológico , Presupuestos , Análisis Costo-Beneficio , Preparaciones de Acción Retardada , Dibenzocicloheptenos , Esquema de Medicación , Costos de los Medicamentos , Costos de la Atención en Salud , Compuestos Heterocíclicos de 4 o más Anillos/administración & dosificación , Compuestos Heterocíclicos de 4 o más Anillos/efectos adversos , Compuestos Heterocíclicos de 4 o más Anillos/economía , Hospitalización , Humanos , Inyecciones Intramusculares , Inyecciones Subcutáneas , Cumplimiento de la Medicación , Palmitato de Paliperidona/administración & dosificación , Palmitato de Paliperidona/efectos adversos , Palmitato de Paliperidona/economía , Piperazinas/administración & dosificación , Piperazinas/efectos adversos , Piperazinas/economía , Esquizofrenia/tratamiento farmacológico , Esquizofrenia/economíaRESUMEN
AIM: To evaluate the cost-effectiveness of aripiprazole once-monthly 400/300 mg (AOM 400) in maintenance monotherapy treatment of bipolar I disorder (BP-I). METHODS: A de novo lifetime Markov model was developed for BP-I using available data for AOM 400 and relevant comparators. Base-case analysis considered costs and outcomes from the US payer perspective. RESULTS: The cost per quality-adjusted life year gained with AOM 400 versus comparators ranged from US$2007 versus oral asenapine to dominance (i.e., lower cost with quality-adjusted life gain) versus long-acting injectable risperidone, paliperidone palmitate, oral cariprazine and best supportive care. Patients treated with AOM 400 were estimated to have fewer mood episodes and hospitalizations per patient (5.37) than comparators (6.33, asenapine or cariprazine; 6.54, risperidone long-acting injectable; 7.64, paliperidone palmitate; and 8.93, best supportive care). Sensitivity analyses showed results were robust to parameter uncertainty. CONCLUSION: AOM 400 may be considered cost effective in the maintenance monotherapy treatment of BP-I in adults.