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Online ISSN: 1099-176X Print
ISSN: 1091-4358 Copyright © 2020 ICMPE. |
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Cost-effectiveness and Price of Aripiprazole for Schizophrenia in the Brazilian Public Health System |
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André Soares Santos,1* Kenya Valéria Micaela de Souza Noronha,2 Mônica Viegas Andrade,2 Cristina Mariano Ruas3 |
1Ph.D., Postdoctoral Researcher, Department
of Economical Sciences, School of Economical Sciences, Universidade Federal de
Minas Gerais (UFMG), Pampulha, Belo Horizonte & Health Technology
Assessment Centre of the UFMG University Hospital (NATS-HC/UFMG),Pampulha, Belo
Horizonte, Brazil |
* Correspondence to: André Soares
Santos, Department of Economical Sciences, School of Economical Sciences,
Universidade Federal de Minas Gerais (UFMG), Av. Presidente Antônio Carlos, 6627,
Pampulha 31.270-901, Belo Horizonte, Brazil.
Tel.:
+55 31 991808788
E-mail:
andresantos111@ufmg.br
Source of Funding: This work was supported by the Brazilian research promoting organizations Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq; grant number 381587/2018-5), Instituto de Avaliação de Tecnologias em Saúde (IATS) and Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG; doctoral scholarship number 436).
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| This study is composed of a cost-effective analysis associated to a process of price adjustment by value-based pricing (VBP) to provide information for decision-making on the incorporation of aripiprazole for the treatment of schizophrenia in Brazil. A three-year Markov model with quarterly cycles was developed to assess the cost-effectiveness of six listed antipsychotic drugs for the first-line treatment of schizophrenia in Brazil and aripiprazole. Outcomes were measured in quality-adjusted life years (QALYs). Olanzapine was considered cost-effective adopting any threshold value. If me-too drugs are required to be least as efficient as the comparators, olanzapine would still be cost-effective when its price is under ≈0.031 USD/mg. Aripiprazole was absolutely dominated by risperidone and was not considered cost-effective even when its price is set at zero. There is no viable price that makes aripiprazole recommended for incorporation for the first-line of treatment of schizophrenia in the Brazilian public health system. | |
Objective: The aims of this study are to conduct a cost-effectiveness analysis of the subsidized antipsychotic drugs for the first-line treatment of schizophrenia in Brazil and aripiprazole, and to discuss a reasonable incorporation price for aripiprazole. Methods: A three-year Markov model with quarterly cycles was developed in TreeAge Pro® 2009 to assess the cost-effectiveness of six listed oral antipsychotic drugs for the first-line treatment of schizophrenia in the Brazilian public health system (haloperidol, chlorpromazine, risperidone, quetiapine, ziprasidone, and olanzapine) and oral aripiprazole. Outcomes were measured in quality-adjusted life years (QALYs). Reasonable prices for aripiprazole were calculated based on the placement of the drug in the efficiency frontier and the cost-effectiveness ratio of the most efficient comparator. Results: Olanzapine was considered cost-effective adopting any threshold value. If me-too drugs are required to be least as efficient as the comparators, olanzapine would still be cost-effective under ≈0.031 USD/mg. Aripiprazole was absolutely dominated by risperidone. The sensitivity analysis showed important uncertainty, which was expected. There is, nevertheless, a prominent separation between ziprasidone, quetiapine and the efficiency frontier. Aripiprazole was not considered cost-effective even when its price was set at zero: CER = $4,102 vs. $3,945 (haloperidol), $3,616 (chlorpromazine), $3,646 (risperidone) and $3,752 (olanzapine) USD/QALY. Conclusion: Olanzapine was considered the most cost-effective drug for the first-line treatment of schizophrenia in Brazil. Aripiprazole was dominated by risperidone and was not considered cost-effective against olanzapine. Implications for Health Care Provision and Use: This work demonstrated, using a price adjustment process, that there is no viable price that would make aripiprazole cost-effective for incorporation in the Brazilian public health system in the first-line of treatment of schizophrenia. The drug can be useful in specific cases, since individual variability of response to antipsychotic drugs is important |
Received 27 July 2019; accepted 14 January 2020
Copyright © 2020 ICMPE