Presentation (CTI)

OBJECTIVES: Paliperidone is a second-generation antipsychotic utilized in schizophrenia with multiple dosage formulations. Each formulation varies in adherence, adverse events, costs, and patient practicality. Existing studies focus on either clinical outcomes or cost-effectiveness; however, none have applied a multi-criteria approach that incorporates diverse clinical, economic, and stakeholder perspectives. A structured framework, such as a multi-criteria decision analysis (MCDA), can clarify trade-offs and guide decision-making. This study aimed to apply an MCDA methodology to assess trade-offs across paliperidone formulations in schizophrenia treatment.
METHODS: A formal MCDA was conducted using the Potentially All Pairwise RanKings of all possible Alternatives (PAPRIKA) method within the 1000Minds software to compare the four paliperidone dosage forms. Criteria were defined from the literature and refined through feedback from various health experts. Stakeholders (n=14) then completed pairwise trade-offs to determine weights across six criteria: adverse events, frequency, route, effectiveness, quality-adjusted life years (QALYs), and practicality of use. Four paliperidone formulations (oral, 1-month, 3-month, and 6-month injectables) were compared.
RESULTS: Practicality of use (32.1%) and frequency of administration (21.2%) were ranked as the most important criteria, together accounting for over 53% of the total decision weight. Practicality of use was ranked most important by 88% of stakeholders, while route carried the least weight (6.8%). All stakeholders (100%) preferred the 6-month injectable (Invega Hafyera) over other formulations, followed by the 3-month, 1-month, and oral formulation. Based on stakeholder preference scores, Invega Hafyera appeared to be the most cost-effective option.
CONCLUSIONS: Expert stakeholders prioritize practicality and dosing frequency when selecting paliperidone formulations. The 6-month injectable was most consistently preferred, suggesting that long-acting formulations may better align with clinical priorities. This study highlights the utility of MCDA as a rigorous and transparent tool for evaluating complex trade-offs in pharmacotherapy, with potential applications in prescribing, formulary decision-making, and the development of evidence-based reimbursement policies within health economics.