OBJECTIVES: Aripiprazole once-monthly 400 mg (AOM-400) has been approved for treatment of schizophrenia in Sweden since November 2013. Other atypical anti-psychotics, risperidone, paliperidone and olanzapine are available as long-acting injectable formulations. A mixed treatment comparison has demonstrated that AOM-400 is at least as efficacious as other atypical long-acting anti-psychotics (ALAIs). However, drug costs vary among the ALAIs as well as the real-world dosing. This analysis aims to investigate the treatment costs of ALAIs using real-world prescription data from Sweden.

METHODS: A one-year time horizon real world budget impact analysis was conducted. All patients in the Swedish prescription registry receiving continuous prescription of an ALAI (paliperidone-LAI (once monthly), risperidone-LAI, olanzapine-LAI or AOM-400) for at least 18 months were included. The Swedish prescription registry contains all prescriptions in Sweden dispensed by any outpatient pharmacy. Four cohorts, one per specific ALAI, were constructed. The average cost per subject receiving a certain ALAI were calculated for the four different cohorts by dividing the sum of individual costs for prescriptions filled day 180-545 (12 months) with the number of subjects in the cohort. The time period was chosen to eliminate titration costs from the analysis. Drug costs were attained from the official national price list.

RESULTS: The resulting treatment cost per patient, per year, for AOM-400 is 39 353 SEK. The expected yearly costs per patient for drug and administration for paliperidone-LAI, risperidone-LAI and olanzapine-LAI are 51 637 SEK, 43 529 SEK and 41 205 SEK respectively.

CONCLUSIONS: In a budget impact analysis, using the method, data and assumptions described, AOM-400 is expected to be cost saving, in the real-world setting, in terms of cost of drug compared to other ALAIs available in Sweden. Using prescription registry data to calculate real-world cost can be an important information source for payers when making coverage decisions.