Budget Impact Analysis of Paliperidone Palmitate in Chronic Schizophrenia in the Mental Health Secretariat-Egyptian Ministry of Health

OBJECTIVES: Our aim is to evaluate the budget impact of long-acting injection paliperidone palmitate (LAI-PP) in chronic schizophrenia versus daily oral antipsychotics from societal perspective over a time horizon of 1 year.

METHODS: A budget impact model was performed to compare LAI-PP to antipsychotics (risperidone, olanzapine and aripiprazole) in chronic schizophrenia patients. Our study included therapies used during relapse and hospitalization, validated by the local clinical practice. The clinical parameters for hospitalization, and adherence of all treatments were extracted from PRIDE trial. Direct medical costs and indirect costs were measured in our study. The unit cost of drug acquisition for all medications were extracted from the Mental Health Secretariat, Ministry of Health, and multiplied by the utilization of each drug. One-way sensitivity analyses were conducted to assess the model uncertainty.

RESULTS: The target population in our model was estimated to be 30 patients. The drug costs when LAI-PP compared to oral antipsychotics were EGP 639,179 and EGP 173,029, respectively, while the non-drug costs of LAI-PP and oral antipsychotics were EGP 707,395 and EGP 1,328,328, respectively. The total costs of LAI-PP (EGP 1.3 million) over one year were less than oral antipsychotics “without paliperidone palmitate” (EGP 1.5 million). LAI-PP produced estimated budget savings of EGP (154,783; budget savings per patient per year was EGP 5,112). On the other side, LAI-PP resulted in 4 hospitalizations avoided per year in comparison to “without paliperidone palmitate”. Sensitivity analyses showed that the percent of hospitalizations for both oral antipsychotics and LAI-PP had the greatest impact on the results.

CONCLUSIONS: The lower hospitalization rates of LAI-PP are offset the increase in upfront costs due to the cost savings from societal perspective compared to the standard of care in chronic schizophrenia. Policy makers should consider this approach to improve patient outcomes and budget sustainability.