OBJECTIVES : To evaluate the cost-effectiveness of lurasidone compared with olanzapine and risperidone in the treatment of Chinese adult patients with schizophrenia.

METHODS : A Markov model was developed from the perspective of the Chinese healthcare system. The model consisted of five health states: non-stabilization, stabilization/adherence, stabilization/non-adherence, relapse, and death. The model time horizon was 15 years and cycle length was 6-week. The efficacy and safety parameters were derived from international multicenter clinical trials, published network meta-analyses and observational studies. Treatment-emergent adverse events of weight gain, extrapyramidal symptoms and diabetes were considered. Health state utilities were extracted from literatures, and costs were estimated from the survey of 5 tertiary hospitals in China, published literatures and official websites. The primary outcomes were total costs, total quality-adjusted life years (QALYs) gained, and incremental cost-effectiveness ratio (ICER). Costs and QALYs were discounted at 5%. Uncertainty was addressed via univariate and probabilistic sensitivity analyses. Also, scenario analyses were conducted.

RESULTS : Compared with olanzapine, lurasidone yielded an improvement of 0.220 QALYs and an incremental cost of CNY 17,396, with the ICER of CNY 79,067/QALY. Compared with risperidone, lurasidone gained an improvement of 0.156 QALYs and incremental cost of CNY 22,707, with the ICER of CNY 145,792/QALY. Based on the generally accepted Chinese ICER threshold of CNY 212,676/QALY (3 times per-capita GDP, 2019 China), lurasidone was found to be a cost-effective intervention. Univariate sensitivity analysis demonstrated that results were sensitive to the risk of diabetes, non-adherence and relapse in the stable phase. Probabilistic sensitivity analysis suggested that lurasidone had 71% of being cost-effective versus olanzapine and risperidone at a willingness-to-pay threshold of CNY 212,676/QALY. Scenario analyses also indicated that lurasidone provided a cost-effective alternative.

CONCLUSIONS : Lurasidone is a cost-effective therapy compared with olanzapine and risperidone in the treatment of Chinese adult patients with schizophrenia.