OBJECTIVES: To compare the real-world costs and budget impact (BI) of five long-acting injectable (LAI) atypical antipsychotics (APs) used in the treatment of schizophrenia in France.

METHODS: Real-world costs were calculated for five atypical LAIs used for the maintenance treatment of schizophrenia in France: aripiprazole, olanzapine pamoate, paliperidone palmitate once-monthly (1M), paliperidone palmitate three-monthly (3M) and risperidone. Analysis of data from real-world sources was undertaken to determine annual treatment costs based on cost per pack/injection and proportion of patients on each dose. A BI model was developed to generate the annual and cumulative net BI of these treatments over a five-year time horizon, capturing all relevant costs: target population, market share, usage frequency, treatment costs, protocol initiation costs (transition from oral to LAI when applicable), and drug administration costs.

RESULTS: Real-world annual treatment costs were estimated as follows: risperidone €3,033; aripiprazole €3,211; olanzapine pamoate €3,653; paliperidone palmitate (1M) €3,480; paliperidone palmitate (3M) €3,348. The analysis indicates that the annual costs of certain LAIs (i.e. without flat pricing across doses) may be higher in actual clinical practice than might be expected based on trial data and dose recommended in the SmPC, due to a larger proportion of patients being treated with the higher doses. In the base case BI model, almost 55,000 patients are treated with atypical LAIs, with a cumulative 5-year total BI of €835 million. The indirect cost of schizophrenia linked to productivity loss in France has previously been estimated at more than €2.2 billion per year, so maintenance treatment to prevent relapses is crucial to reduce the humanistic and economic burden.

CONCLUSIONS: Most of the atypical LAI APs in France do not have flat pricing across doses. Hence, greater usage of the higher doses in actual clinical practice leads to higher treatment costs than would be anticipated based on the SmPC-recommended dosing.