Cost-effectiveness of long-acting injectable paliperidone palmitate versus haloperidol decanoate in maintenance treatment of schizophrenia

Robert A. Rosenheck, Douglas L. Leslie, Kyaw J. Sint, Haiqun Lin, Yue Li, Joseph Patrick McEvoy, Matthew J. Byerly, Robert M. Hamer, Marvin S. Swartz, T. Scott Stroup

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objective: This study assessed the relative cost-effectiveness of haloperidol decanoate (HD), a first-generation long-acting injectable (LAI) antipsychotic, and paliperidone palmitate (PP), a second-generation LAI antipsychotic. Methods: A double-blind, randomized 18-month clinical trial conducted at 22 clinical research sites in the United States compared the cost-effectiveness of HD and PP among 311 adults with schizophrenia or schizoaffective disorder who had been clinically assessed as likely to benefit from an LAI antipsychotic. Patients were randomly assigned to monthly intramuscular injections of HD (25-200 mg) or PP (39-234 mg) for up to 24 months. Quality-adjusted life years (QALYs) were measured by a schizophrenia-specific algorithm based on the Positive and Negative Syndrome Scale and side-effect assessments; total health care costs were assessed from the perspective of the health system. Results: Mixed-model analysis showed that PP was associated with .0297 greater QALYs over 18 months (p=.03) and with $2,100 more in average costs per quarter for inpatient and outpatient services and medication compared with HD (p<.001). Bootstrap analysis with 5,000 replications showed an incremental cost-effectiveness ratio for PP of $508,241 per QALY (95% confidence interval=$122,390-$1,582,711). Net health benefits analysis showed a .98 probability of greater cost-effectiveness for HD compared with PP at an estimated value of $150,000 per QALY and a .50 probability of greater cost-effectiveness at $500,000 per QALY. Conclusions: HD was more cost-effective than PP, suggesting that PP's slightly greater benefits did not justify its markedly higher costs, which are likely to fall once the medication's patent expires.

Original languageEnglish (US)
Pages (from-to)1124-1130
Number of pages7
JournalPsychiatric Services
Volume67
Issue number10
DOIs
StatePublished - Oct 1 2016

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Cost-Benefit Analysis
Quality-Adjusted Life Years
Schizophrenia
Injections
Antipsychotic Agents
Costs and Cost Analysis
Therapeutics
Intramuscular Injections
Insurance Benefits
Ambulatory Care
Paliperidone Palmitate
haloperidol decanoate
Double-Blind Method
Health Care Costs
Psychotic Disorders
Inpatients
Clinical Trials
Confidence Intervals
Health
Research

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Cost-effectiveness of long-acting injectable paliperidone palmitate versus haloperidol decanoate in maintenance treatment of schizophrenia. / Rosenheck, Robert A.; Leslie, Douglas L.; Sint, Kyaw J.; Lin, Haiqun; Li, Yue; McEvoy, Joseph Patrick; Byerly, Matthew J.; Hamer, Robert M.; Swartz, Marvin S.; Stroup, T. Scott.

In: Psychiatric Services, Vol. 67, No. 10, 01.10.2016, p. 1124-1130.

Research output: Contribution to journalArticle

Rosenheck, RA, Leslie, DL, Sint, KJ, Lin, H, Li, Y, McEvoy, JP, Byerly, MJ, Hamer, RM, Swartz, MS & Stroup, TS 2016, 'Cost-effectiveness of long-acting injectable paliperidone palmitate versus haloperidol decanoate in maintenance treatment of schizophrenia', Psychiatric Services, vol. 67, no. 10, pp. 1124-1130. https://doi.org/10.1176/appi.ps.201500447
Rosenheck, Robert A. ; Leslie, Douglas L. ; Sint, Kyaw J. ; Lin, Haiqun ; Li, Yue ; McEvoy, Joseph Patrick ; Byerly, Matthew J. ; Hamer, Robert M. ; Swartz, Marvin S. ; Stroup, T. Scott. / Cost-effectiveness of long-acting injectable paliperidone palmitate versus haloperidol decanoate in maintenance treatment of schizophrenia. In: Psychiatric Services. 2016 ; Vol. 67, No. 10. pp. 1124-1130.
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AU - Leslie, Douglas L.

AU - Sint, Kyaw J.

AU - Lin, Haiqun

AU - Li, Yue

AU - McEvoy, Joseph Patrick

AU - Byerly, Matthew J.

AU - Hamer, Robert M.

AU - Swartz, Marvin S.

AU - Stroup, T. Scott

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