Cost-utility analysis of lurasidone for the first-line treatment of schizophrenia in China

OBJECTIVE: To evaluate the cost-effectiveness of lurasidone compared with olanzapine and risperidone in the first-line treatment of patients with schizophrenia from a Chinese healthcare system perspective. METHODS: A Markov model with 6-week cycle was constructed to reflect the disease progression of schizophrenia patients in the acute and maintenance phase. Probabilities of treatment discontinuation and adverse events in the acute phase were derived from the 6-week lurasidone clinical trial and a published network meta-analysis; long-term risks of relapse and discontinuation were estimated based on the 12-month lurasidone clinical trial and other treatment comparison studies. Cost inputs were derived from published literature and Chinese official documents, supplemented by expert opinions when necessary. Utility values were taken from published literature. Costs and quality-adjusted life-years (QALYs) were assessed over 15 years with a discount rate of 5% per year. RESULTS: Over a 15-year time horizon, lurasidone yielded an improvement of 0.197 QALYs with a cost saving of CN¥12,093 (US$1,753) vs. olanzapine and an improvement of 0.116 QALYs with a cost saving of CN¥6,781 (US$983) vs. risperidone. One-way sensitivity analyses demonstrated robust base-case results since all analyses yielded net monetary benefits >0 at a willingness-to-pay threshold of CN¥72,447.00 (US$10,499.57)/QALY. Probabilistic sensitivity analyses suggested that lurasidone had 99.7, 99.9, and 100% probability of being cost-effective vs. olanzapine and risperidone at the conventional decision thresholds of 1, 2, and 3 times the Chinese per capita gross domestic product [namely CN¥72,447.00 (US$10,499.57)/QALY, CN¥1,44,894.00 (US$20,999.13)/QALY, and CN¥2,17,341.00 (US$31,498.70)/QALY in 2020], respectively. CONCLUSION: Treatment with lurasidone was predicted to improve health outcomes and be a dominant strategy for patients with schizophrenia, compared with olanzapine and risperidone, in China.