Cost-utility of aripiprazole once-monthly versus paliperidone palmitate once-monthly injectable for schizophrenia in China.
<h4>Objectives</h4>From the perspective of Chinese healthcare system, this study compared the cost-utility of aripiprazole once-monthly (AOM) and paliperidone palmitate once-monthly injectable (PP1M) in the treatment of adult patients with schizophrenia in China.<h4>Methods</h4&...
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Public Library of Science (PLoS)
2025-01-01
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| Online Access: | https://doi.org/10.1371/journal.pone.0317393 |
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| author | Yiping An Gang Fang Zhipeng Pi Yumeng Zhang Wei Li Jinxi Ding |
| author_facet | Yiping An Gang Fang Zhipeng Pi Yumeng Zhang Wei Li Jinxi Ding |
| author_sort | Yiping An |
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| description | <h4>Objectives</h4>From the perspective of Chinese healthcare system, this study compared the cost-utility of aripiprazole once-monthly (AOM) and paliperidone palmitate once-monthly injectable (PP1M) in the treatment of adult patients with schizophrenia in China.<h4>Methods</h4>A 5-state Markov model was developed to evaluate the cost-utility of 10 years of long-acting injections (LAI) treatment for schizophrenia. The long-term costs and quality-adjusted life years (QALYs) were estimated, with the incremental cost-effectiveness ratio (ICER) as the primary outcome. The annual discount rate was set at 5%. A cost-effectiveness threshold (CET) of 0.51 times China's 2023 gross domestic product (GDP) (US$ 6,394.536) was used to judge the economics of intervention.<h4>Results</h4>The current price of AOM in China is relatively high (US$418.140). To assess its cost-effectiveness in the context of potential price negotiations with China Healthcare Security Administration (CHS) for inclusion in the National Reimbursement Drug List (NRDL), we simulated a 40% price reduction (US$257.619). At a CET of 0.51 times GDP per capita (US$6,394.536), the base-case analysis showed that the incremental costs of AOM relative to PP1M after 10 years of treatment were US$1,926.373 with an incremental gain of 0.306 QALYs. The ICER for AOM was US$6,285.303 per QALY, which is below the CET, indicating that AOM is cost-effective. One-way sensitivity analysis identified AOM's drug cost as the parameter with the greatest impact on results. Probabilistic sensitivity analysis revealed that with a 40% price reduction, the probability of AOM being cost-effective is only 41.70%. However, with a 60% price reduction, AOM became dominantly cost-effective, with the probability increasing to 100%. When the CET was relaxed to 0.90 times GDP per capita (US$11,284.476), the probability of cost-effectiveness for AOM after a 40% price reduction rose to 85.10%. Scenario analyses conducted over a time horizon extending from 10 to 30 years showed that the ICER decreased significantly with longer follow-up, gradually approaching the 0.51GDP threshold and remaining below the 0.90 GDP threshold throughout the analysis.<h4>Conclusions</h4>The cost-effectiveness of AOM relative to PP1M is highly influenced by its price and the CET. Healthcare decision makers or clinical users need to balance innovation incentives and accessibility. |
| format | Article |
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| institution | Kabale University |
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| language | English |
| publishDate | 2025-01-01 |
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| spelling | doaj-art-34bf4c51fc534451b7e38773ddb712a22025-08-20T03:29:53ZengPublic Library of Science (PLoS)PLoS ONE1932-62032025-01-01206e031739310.1371/journal.pone.0317393Cost-utility of aripiprazole once-monthly versus paliperidone palmitate once-monthly injectable for schizophrenia in China.Yiping AnGang FangZhipeng PiYumeng ZhangWei LiJinxi Ding<h4>Objectives</h4>From the perspective of Chinese healthcare system, this study compared the cost-utility of aripiprazole once-monthly (AOM) and paliperidone palmitate once-monthly injectable (PP1M) in the treatment of adult patients with schizophrenia in China.<h4>Methods</h4>A 5-state Markov model was developed to evaluate the cost-utility of 10 years of long-acting injections (LAI) treatment for schizophrenia. The long-term costs and quality-adjusted life years (QALYs) were estimated, with the incremental cost-effectiveness ratio (ICER) as the primary outcome. The annual discount rate was set at 5%. A cost-effectiveness threshold (CET) of 0.51 times China's 2023 gross domestic product (GDP) (US$ 6,394.536) was used to judge the economics of intervention.<h4>Results</h4>The current price of AOM in China is relatively high (US$418.140). To assess its cost-effectiveness in the context of potential price negotiations with China Healthcare Security Administration (CHS) for inclusion in the National Reimbursement Drug List (NRDL), we simulated a 40% price reduction (US$257.619). At a CET of 0.51 times GDP per capita (US$6,394.536), the base-case analysis showed that the incremental costs of AOM relative to PP1M after 10 years of treatment were US$1,926.373 with an incremental gain of 0.306 QALYs. The ICER for AOM was US$6,285.303 per QALY, which is below the CET, indicating that AOM is cost-effective. One-way sensitivity analysis identified AOM's drug cost as the parameter with the greatest impact on results. Probabilistic sensitivity analysis revealed that with a 40% price reduction, the probability of AOM being cost-effective is only 41.70%. However, with a 60% price reduction, AOM became dominantly cost-effective, with the probability increasing to 100%. When the CET was relaxed to 0.90 times GDP per capita (US$11,284.476), the probability of cost-effectiveness for AOM after a 40% price reduction rose to 85.10%. Scenario analyses conducted over a time horizon extending from 10 to 30 years showed that the ICER decreased significantly with longer follow-up, gradually approaching the 0.51GDP threshold and remaining below the 0.90 GDP threshold throughout the analysis.<h4>Conclusions</h4>The cost-effectiveness of AOM relative to PP1M is highly influenced by its price and the CET. Healthcare decision makers or clinical users need to balance innovation incentives and accessibility.https://doi.org/10.1371/journal.pone.0317393 |
| spellingShingle | Yiping An Gang Fang Zhipeng Pi Yumeng Zhang Wei Li Jinxi Ding Cost-utility of aripiprazole once-monthly versus paliperidone palmitate once-monthly injectable for schizophrenia in China. PLoS ONE |
| title | Cost-utility of aripiprazole once-monthly versus paliperidone palmitate once-monthly injectable for schizophrenia in China. |
| title_full | Cost-utility of aripiprazole once-monthly versus paliperidone palmitate once-monthly injectable for schizophrenia in China. |
| title_fullStr | Cost-utility of aripiprazole once-monthly versus paliperidone palmitate once-monthly injectable for schizophrenia in China. |
| title_full_unstemmed | Cost-utility of aripiprazole once-monthly versus paliperidone palmitate once-monthly injectable for schizophrenia in China. |
| title_short | Cost-utility of aripiprazole once-monthly versus paliperidone palmitate once-monthly injectable for schizophrenia in China. |
| title_sort | cost utility of aripiprazole once monthly versus paliperidone palmitate once monthly injectable for schizophrenia in china |
| url | https://doi.org/10.1371/journal.pone.0317393 |
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