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Online ISSN: 1099-176X    Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 23, Issue 1, 2020. Pages: 27-37
Published Online: 1 March 2020

Copyright © 2020 ICMPE.


 

Cost-effectiveness and Price of Aripiprazole for Schizophrenia in the Brazilian Public Health System

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
2Ph.D., Professor, Department of Economical Sciences, School of Economical Sciences, Universidade Federal de Minas Gerais (UFMG), Pampulha, Belo Horizonte, Brazil
3Ph.D., Professor, Department of Social Pharmacy, School of Pharmacy, Universidade Federal de Minas Gerais (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).

Abstract
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.


Background: Schizophrenia is a chronic debilitating condition characterized by disorders in thought, affect and behavior. Considering the low effectiveness of antipsychotic drugs for schizophrenia and the potentially high cost of an inadequate choice, a systematic cost-effectiveness evaluation of the list of subsidized antipsychotic drugs is necessary in order to allow an adequate choice of pharmacotherapy for the patient and the financial reality of the Brazilian public health system (SUS).

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

Supplementary materials

Received 27 July 2019; accepted 14 January 2020

Copyright 2020 ICMPE