Cost-Effectiveness of Aripiprazole 2-Month Ready-to-Use 960 mg Long-Acting Injectable for the Treatment of Patients With Schizophrenia

Abstract: Background: Aripiprazole 2-month Ready to Use 960 mg (ARI 2M RTU) is a long-acting injectable antipsychotic (LAI) in development for treatment of schizophrenia and maintenance treatment of bipolar I disorder. This pharmacokinetic-pharmacodynamic-pharmacoeconomic model examined the clinical (relapses) and cost implications of ARI 2M RTU versus aripiprazole lauroxil 1064 mg (AL 1064) for treatment of schizophrenia. Methods: A Markov model with health states for remission, relapses and death estimated relapses avoided and costs over one year from a US payer perspective. Pharmacokinetic data were used to derive plasma concentrations, which were used to estimate mean relapses for each LAI in the pharmacodynamic portion of the model. Cost data included relapse, drug acquisition (wholesale average cost (WAC) for AL 1064 and expected WAC for ARI 2M RTU) and administration costs. Cost per relapse avoided and the cost-effectiveness probability were estimated for ARI 2M RTU versus AL 1064. Results: Treatment with ARI 2M RTU resulted in a lower mean number of relapses per patient versus AL 1064 (0.289 vs. 0.333) but higher total costs ($28,310 vs. $24,017). The incremental cost per relapse avoided was $97,568. For willingness-to-pay thresholds below $200,000 per relapse avoided, the cost-effectiveness probability of ARI 2M RTU ranged up to 57%, with ARI 2M RTU having higher cost-effectiveness probabilities than AL 1064 above a threshold of ~$117,000. Conclusion: This model suggests that ARI 2M RTU resulted in fewer relapses with slightly higher costs versus AL 1064 and could be a cost-effective alternative for the treatment of schizophrenia in the US.Short Description: This pharmacokinetic-pharmacodynamic-pharmacoeconomic model examined the clinical (relapses) and cost implications of aripiprazole 2-month ready-to-use 960mg (ARI 2M RTU) versus aripiprazole lauroxil 1064mg (AL 1064) for the treatment of schizophrenia. A Markov model estimated relapses avoided and costs over a one-year timehorizon from a US payer perspective. Treatment with ARI 2M RTU resulted in less relapses but higher costs versus AL 1064, suggesting ARI 2M RTU could be a cost-effective treatment of schizophrenia in the US.Name of Sponsoring Organization(s): Otsuka Pharmaceutical Development & Commercialization Inc.