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An economic evaluation of aripiprazole vs olanzapine adapted to the Italian setting using outcomes of metabolic syndrome and risk for diabetes in patients with schizophrenia

Authors Colombo GL, Caruggi M, Di Matteo S, Rossi A

Published 10 October 2008 Volume 2008:4(5) Pages 967—976


Review by Single anonymous peer review

Peer reviewer comments 2

Giorgio L Colombo1, Mauro Caruggi2, Sergio Di Matteo1, Alessandro Rossi3

1S.A.V.E. Studi Analisi Valutazioni Economiche, Milano, Italy; 2Università degli Studi dell’Insubria, Varese, Italy; 3Università de L’Aquila, Italy

Objective: To evaluate the cost-effectiveness of aripiprazole and olanzapine in patients with schizophrenia.

Methods: Data from a double-blind, randomized study demonstrating the efficacy of aripiprazole and olanzapine were used to observe new incidence of metabolic syndrome (26-week therapy) and to model the risk of developing diabetes over 5 years of therapy. Cumulative incidence of metabolic syndrome was compared using Kaplan–Meier estimates; diabetes risk was estimated using a validated, general population risk-prediction model. Economic assessment was conducted from the third-party payer perspective by evaluating pharmacotherapy costs of treating schizophrenia and medical costs associated with treating adverse metabolic effects in a hypothetical cohort of 1000 patients. Resource utilization and costs were derived from the underlying study and published data, using a 3% rate to discount costs and benefits.

Results: For the patients switched from olanzapine to aripiprazole, treatment with aripiprazole was a dominant cost-saving strategy. Use of aripiprazole avoided 184 events of metabolic syndrome over 26 weeks of treatment, contributing to a real-world (RW) cost savings of €2.53 per patient and a total savings of approximately €465.52 over a 5-year period. For the same cohort, the risk-prediction model indicated that 34 occurrences of diabetes could be avoided over 5 years, corresponding to a RW cost savings of €56.86 per patient and a total saving of approximately €1,933.24. These savings reflect avoided costs in treating adverse metabolic events and comparable costs in the acquisition of aripiprazole.

Conclusions: Maintenance aripiprazole therapy offers medical and economic benefits over olanzapine, reflected by reduced incidence of metabolic syndrome and diabetes and associated lower costs.

Keywords: schizophrenia, cost-consequences, apripiprazole, olanzapine, metabolic syndrome, diabetes

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