Rajagopalan Krithika, Meyer Kellie, O'Day Ken, Denno Melissa, Loebel Antony
a a Sunovion Pharmaceuticals Inc. , Marlborough , MA , USA.
b b Xcenda, L.L.C. , Palm Harbor , FL , USA.
J Med Econ. 2015;18(10):821-7. doi: 10.3111/13696998.2015.1052462. Epub 2015 Jul 27.
Bipolar disorder imposes a high economic burden on patients and society. Lurasidone and quetiapine extended-release (XR) are atypical antipsychotic agents indicated for monotherapy treatment of bipolar depression. Lurasidone is also indicated as adjunctive therapy with lithium or valproate for depressive episodes associated with bipolar disorder. The objective of this analysis was to estimate the cost-effectiveness of lurasidone and quetiapine XR in patients with bipolar depression.
A cost-effectiveness model was developed to compare lurasidone to quetiapine XR. The model was based on a US third-party payer perspective over a 3-month time horizon. The effectiveness measure in the model was the percentage of patients achieving remission (Montgomery-Åsberg Depression Rating Scale [MADRS] total score ≤12 by weeks 6-8). The comparison of remission rates was made through an adjusted indirect treatment comparison of lurasidone and quetiapine XR pivotal trials using placebo as the common comparator. Resource utilization for remission vs no remission was estimated from published expert panel data, and resource costs were obtained from a retrospective database study of bipolar I depression patients. Drug costs were estimated using the mean dose from clinical trials and wholesale acquisition costs.
Over the 3-month model time period, lurasidone and quetiapine XR patients, respectively, had similar mean numbers of emergency department visits (0.48 vs 0.50), inpatient days (2.1 vs 2.2), and office visits (9.3 vs 9.6). More lurasidone than quetiapine XR patients achieved remission (52.0% vs 43.2%) with slightly higher total costs ($4982 vs $4676), resulting in an incremental cost-effectiveness ratio of $3474 per remission. The probabilistic sensitivity analysis showed lurasidone had an 86% probability of being cost-effective compared to quetiapine XR at a willingness-to-pay threshold of $10,000 per remission.
Lurasidone may be a cost-effective option when compared to quetiapine XR for the treatment of adults with bipolar depression.
双相情感障碍给患者和社会带来了沉重的经济负担。鲁拉西酮和喹硫平缓释片（XR）是用于双相抑郁单药治疗的非典型抗精神病药物。鲁拉西酮也被用作与锂盐或丙戊酸盐联合治疗双相情感障碍相关抑郁发作的辅助疗法。本分析的目的是评估鲁拉西酮和喹硫平XR在双相抑郁患者中的成本效益。
建立了一个成本效益模型，以比较鲁拉西酮和喹硫平XR。该模型基于美国第三方支付方的视角，时间跨度为3个月。模型中的有效性指标是实现缓解的患者百分比（蒙哥马利-奥斯伯格抑郁量表[MADRS]总分在第6至8周时≤12）。缓解率的比较是通过对鲁拉西酮和喹硫平XR关键试验进行调整后的间接治疗比较，以安慰剂作为共同对照。根据已发表的专家小组数据估计缓解与未缓解的资源利用情况，并从一项关于双相I型抑郁患者的回顾性数据库研究中获取资源成本。药物成本使用临床试验中的平均剂量和批发采购成本进行估计。
在3个月的模型时间段内，鲁拉西酮组和喹硫平XR组患者的急诊就诊平均次数（分别为0.48次和0.50次）、住院天数（分别为2.1天和2.2天）和门诊就诊次数（分别为9.3次和9.6次）相似。实现缓解的鲁拉西酮组患者比喹硫平XR组患者更多（52.0%对43.2%），总成本略高（分别为4982美元和4676美元），导致每例缓解的增量成本效益比为3474美元。概率敏感性分析显示，在每例缓解支付意愿阈值为10000美元时，与喹硫平XR相比，鲁拉西酮具有成本效益的概率为86%。
与喹硫平XR相比，鲁拉西酮可能是治疗成年双相抑郁患者的一种具有成本效益的选择。
