OBJECTIVES:

The objective was to estimate the budget impact of introducing paliperidone palmitate 3-monthly for the maintenance treatment of schizophrenia to the English NHS setting.

METHODS:

A 1-year budget impact model was developed based on epidemiological estimates of adults who had previously experienced two relapses of schizophrenia. An English real world data study informed the number of hospital admissions and length of stay. Two scenarios were simulated: 1) the current setting, in which patients were prescribed their current antipsychotic drugs, and 2) the proposed setting, including potential displacement of current antipsychotics from switching treatment to paliperidone palmitate 3-monthly. The budget impact analysis incorporated drug acquisition, drug administration and hospitalisation costs. Univariate sensitivity analyses were conducted, including analyses assessing the impact of differential rates of displacement.

RESULTS:

The current estimated annual cost of schizophrenia in the English NHS adult population with two relapses was approximately £660m, with 46,479 admissions and 1,389,985 bed days. Assuming a displacement of 25% oral anti-psychotic and risperidone long acting injectable (RLAI) patients, and 70% of paliperidone palmitate 1-monthly patients, paliperidone palmitate 3-monthly was associated with estimated net savings of £42m, a reduction of 7,241 admissions and a reduction of 240,084 bed days. In an alternative scenario, increasing only the displacement of oral anti-psychotics and RLAI to 50%, paliperidone palmitate 3-monthly was associated with estimated net savings of £79 million, a reduction of 14,483 hospital admissions and a reduction of 506,549 bed days.

CONCLUSIONS:

Introducing paliperidone palmitate 3-monthly was associated with significant cost savings. Cost savings were driven predominantly by reductions in drug administration costs and hospitalisation costs associated with relapse, compared to orals and RLAI.