Cost-Offset Analysis of Aripiprazole Once-Monthly Long-Acting Injectable in Patients With First-Episode or Early-Phase Schizophrenia

This work was sponsored by Otsuka Pharmaceutical Development & Commercialization Inc., Princeton, NJ, USA and H. Lundbeck LLC, Deerfield, IL, USA Schizophrenia is characterized by recurring episodes of relapse, with progressive functional decline and lasting neurological damage. While continuous antipsychotic treatment plays a key role in preventing relapses in schizophrenia, a high proportion of patients remain nonadherent to their medication, especially in the early phase of the illness. A long-acting injectable formulation of the atypical antipsychotic, aripiprazole monohydrate once-monthly (AOM), was developed as maintenance treatment for patients living with schizophrenia or bipolar-I disorder. In the previous cluster-randomized PRELAPSE study, AOM resulted in a significant and clinically meaningful 44% reduction in the incidence of first hospitalization in patients aged 18-35 years with first-episode or early phase schizophrenia (n=234) compared to the clinician’s choice of antipsychotic medication (n=255). Based on the PRELAPSE study, a cost-offset model was designed to measure the economic impact of treatment with AOM among patients living with first-episode or early phase schizophrenia. The variables considered in the model included time to first hospitalization, direct costs related to medication, healthcare resource utilization and associated costs, and the costs of managing adverse events. This analysis estimated that total direct medical costs in patients treated with AOM were lower than in patients receiving clinician’s choice of medication ($118,976 and $134,500, respectively), mainly due to hospitalization costs, which were reduced by 27%. The significant cost savings through early initiation of treatment with AOM may provide an indication of its potential overall economic benefit. This analysis may help inform payor decision-making when considering antipsychotic medications for treating patients with first-episode or early phase schizophrenia.