Updated Cost-Effectiveness Analysis of Brexpiprazole for Adjunctive Treatment in Major Depressive Disorder in the United States

Abstract: Background: A 2017 published cost-effectiveness analysis of brexpiprazole compared to quetiapine-150 mg/day, quetiapine-300 mg/day, olanzapine/fluoxetine 50mg-12mg/day and antidepressant therapy (ADT) alone showed that, over a 48-week time horizon, adjunctive brexpiprazole returned favorable incremental cost-effectiveness ratios (ICERs) ranging from $20,000 to $50,000. This study assessed how the cost-effectiveness of brexpiprazole is impacted by its price increase (2017-2022) and current medical resource use and costs. Methods: We used a three-part model consisting of two 6-week decision trees to assess treatment response and remission, respectively, and a six 6-week cycle Markov model. We used clinical data from brexpiprazole pivotal trials and related literature. Only direct medical expenditures were considered. Drug costs were based on the current wholesale acquisition cost from Redbook. For drugs with generic versions, blended prices were estimated based on market shares and generic/branded prices. The remaining health care costs were sourced from the literature and inflated to 2022 prices. Results Adjunctive brexpiprazole was cost-effective (incremental cost per additional responder) compared to all comparators at a willingness to pay of $US 100,000. Furthermore, the current price of brexpiprazole (2022 price - $US 44.41) was lower than the target ($US 48.19 - $US 95.33), implying that it still has an economically justified price. Adjunctive brexpiprazole was cost-effective (incremental cost per additional remitter) compared to quetiapine 150 mg/day and ADT alone at a WTP of $US 100,000. Conclusion Adjunctive brexpiprazole was cost-effective and economically justified in patients with MDD at 2022 prices when compared to quetiapine (150/300 mg/day), olanzapine/fluoxetine 50mg-12mg/day and ADT alone.Short Description: The following is a cost effectiveness analysis of brexpiprazole, compared to quetiapine (150/300 mg/day), olanzapine/fluoxetine 50mg-12mg/day and ADT alone, for the treatment of major depressive disorder (MDD) in the United States. Our results suggest that adjunctive brexpiprazole was cost-effective and economically justified in patients with MDD at 2022 prices when compared to the aforementioned treatment alternatives.Name of Sponsoring Organization(s): Otsuka Pharmaceutical Development & Commercialization, Inc.