Modelling the Costs of Illness and the Costs of Relapse in ...
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Modelling the Costs of Illness and
the Costs of Relapse in the
Management of Schizophrenia
in the UKLaunois R., Présenté G. - Réseau d’Evaluation en Economie de la Santé (REES France), Paris (France) - Hansen K.,
Toumi M. - Lundbeck, Paris (France)
ISPOR Fourth European Congress
CANNES (France) - 11 / 13 November 2001
REES France : Réseau d ’Evaluation en Economie de la Santé
http://smbh7.smbh.univ-paris13.fr
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AIMS OF THE STUDY
▪ To compare the toxicities of atypical treatments for
schizophrenic patients
▪ To study their consequences on compliance and relapse
▪ To specify management pathways in UK for patients under
treatment
▪ To analyze the mean cost incurred by relapsing and not
relapsing patients treated with atypical antipsychotics in
the British society
▪ To analyze the total 10 years and life time costs incurred by
the National Health Service
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METHODS
▪ Simulation model
▪ Clinical states
▪ Management structures
▪ Clinical events
▪ 10 years and life time cost
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Mentally ill Patients’ Accomodation in UK
L-S Hospital
Collective
Residence
staffed
FH
DH
NH
DCC
CMHC
AMBULATORY VISITS
Private
Residence
Non-staffed
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Classification Algorithm
Living in a staffed accommodation?
Schizophrenic Patient
Long-stay
inpatient
hospitalisation
Intensive
Collective Care
ICC
Full-time hospitalisation>180 days?
Collective care Personal care
Staff resident ratio
> 0,5?
Indicateur de prise
en charge > 120?
yes no
In group home
settings?
Mild
Collective Care
MCC
Intensive
Personal
Care IPC
Mild
Personal
Care MPC
no
no
no
yes
yes
yes
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Heavy Hospital
Management
Home Hostel
Intensive management
Standard management
Patient’s Care Management Groups
Patient’s residence
IPC
Inte
nsi
ty o
f ca
re
ICC
MPC MCC
L-S Hospital
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Clinical States
▪ Relapse (5 states)
▪ Non-Relapse (5 states)
▪ Chronic (5 states)
▪ Lost to follow up (1 state)
▪ Death (1 state)
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ISPOR - 11/13 Nov. 2001 PL-2238/01 8
Simulation Model
▪ 17 Markov states (R+, R-, chro, DO, DC)
▪ 8 160 variables
▪ 18 213 nodes
▪ Software Data for Windows version 3.15
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ISPOR - 11/13 Nov. 2001 PL-2238/01 9
Markov Model in Schizophrenia
Sertindole
Olanzapine
Risperidone
Others
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Markov Model in Schizophrenia
Hospital
ICC
IPC
MPC
MPC
DO
Death
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ISPOR - 11/13 Nov. 2001 PL-2238/01 11
Markov Model in Schizophrenia
EPS
Drowsiness
Weight gain
Sexual dysfunction
M tox
Comp
Comp +
Comp -
Relapse
R+
R-
GO
VV
DO
DC
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ISPOR - 11/13 Nov. 2001 PL-2238/01 12
Markov Model in Schizophrenia
Hospital
ICC
IPC
MCC
In
Amb
Int
Mild
Resid
Home MPC
Resid
Home
Death
DO
Hospital
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ISPOR - 11/13 Nov. 2001 PL-2238/01 13
Markov Model in Schizophrenia
Hospital
ICC
IPC
MCC
DO
EPS
Drowsiness
Weight gain
Sexual dysfunction
M tox
Comp
Comp +
Comp -
Relapse
R+
In
Amb
Int
Mild
Resid
Home
Hospital
Death
Hospital
ICC
IPC
MPC
MPC
DO
Death
R-
GO
VV
MPC
Resid
Home
DO
DC
Sertindole
Risperidone
Others
Olanzapine
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ISPOR - 11/13 Nov. 2001 PL-2238/01 14
Frequency of Side Effects
Short term studies
Sertindole Olanzapine Risperidone
% % %
EPS 19 21 28
Drowsiness 8.2 26 7.9
Weight gain 20.6 30 15.7
Sexual dysfunction 2.8 1 0
Total 50.6 78 51.6
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ISPOR - 11/13 Nov. 2001 PL-2238/01 15
Compliance Rate Assumptions
All products
Range
EPS 0.20 0.10-0.60
Somnolence 0.20 0.10-0.60
Weight Gain 0.40 0.10-0.60
Sexual disturbance 0.40 0.10-0.60
Minor toxicity 0.80 0.40-0.90
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Non-compliance and Effectiveness
Authors Date n Annual rate
Probabili ty
per s ix
months
Del Giudice 1975 57 76% 0.680
Weiden 1995 373 76% 0.510
Glaser 1996 nd 75% 0.509
Baldessarin i 1990 3939 74% 0.490
Kis sl ing 1993 1224 72% 0.470
Johnss on 1983 60 65% 0.400
Gilbert 1993 1224 61% 0.375
Davis 1995 278 46% 0.265
Relapse rate
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Compliance and Effectiveness
Authors Date n Annual rateProbabili ty per
six m onths
Del Giudice 1975 25 44% 0,250
Weiden 1995 285 35% 0,194
23% 0,117
Baldessarin i 1990 3939 30% 0,160
Davis 1995 249 29% 0,157
Glaser 1996 nd 20% 0,105
Gilbert 1993 3114 20% 0,105
Kis sl ing 1993 270 16% 0,080
Johnss on 1983 60 16% 0,080
Relapse rate
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Prices of Anti-Psychotic Treatment
Daily cost Six monthly cost
Haloperidol
15 mg / day 0.36 £ 01 65.61 £ 01
Sertindole
16 mg / day 3.20 £ 01 582.40 £ 01
Olanzapine
15 mg / day 5.28 £ 01 951.21 £ 01
Risperidone
5 mg / day 3.24 £ 01 590.86 £ 01
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Mean Consumption by Patient Per Six Months £01
L-S Hospital Intensive
Residential
Intensive
home Mild Residential
Mild
home
COHORTE STUDY RELAPSE (n=77)
Complete hospitalisation days 3 182.00 0.00 14 805.00 6 382.00
Day hospitalisation days 75.86 0.00 0.00 134.48
Ambulatory contacts 1 273.19 0.00 532.50 1 717.55
TOTAL 4 476.00 0.00 15 337.00 8 235.00
COHORTE STUDY NON-
RELAPSE (n=68)
Complete hospitalisation (days) 0.00 0.00 0.00 0.00
Day hospitalisation (days) 0.00 0.00 1 888.00 100.00
Ambulatory contacts 1 239.70 0.00 2 114.00 1 918.00
TOTAL 1 240.00 0.00 4 012.00 2 020.00
CHRONIC 25 662.00
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ISPOR - 11/13 Nov. 2001 PL-2238/01 20
Discount Rate Assumptions
▪ Discount rate
– 10 year : 3%
– Lifetime : 6%
▪ Cost of management with other atypical
antipsychotics
– 10 year: Average (Sertindole, Risperidone &
Olanzapine + 1.5%
– Lifetime: Average (Sertindole, Risperidone &
Olanzapine + 5%
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ISPOR - 11/13 Nov. 2001 PL-2238/01 21
Point Prevalence for Psychoses
▪ Adults aged 16-64 is 4/1000
Source: British survey, Office of Population Censuses and Surveys
Population
United kingdom 52 000 000
Age group 16-64 45 000 000
Prevalence 180 000
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ISPOR - 11/13 Nov. 2001 PL-2238/01 22
RESULTS
▪ 10 years cost per patient, per clinical state
▪ Overall 10 years cost per patient
▪ Life years cost per patient, per clinical state
▪ Overall life years cost per patient
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ISPOR - 11/13 Nov. 2001 PL-2238/01 23
Projected 10 Years Cost
per Patient by Clinical State £01
Cohorte Olanzapine Risperidone Sertindole Others
Relapse 53 097 48 670 47 959 50 657
Non-relapse 15 444 16 241 16 513 16 307
TOTAL 68 541 64 911 64 472 66 964
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Overall 10 Years Cost
per Patient £01
Drugs Market share % Weighted cost
Olanzapine 33.38 22 878
Risperidone 28.31 18 378
Sertindole 12.32 7 940
Others 25.99 17 407
Total 100 66 603
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24 327
2 053
24 19714 508
1 518
0
Predicted 10 Years Cost per Patient by Clinical Status and Type of Management £01
R + R -50 57716 026
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ISPOR - 11/13 Nov. 2001 PL-2238/01 26
10 Years Cost for non relapsing
Patient by Type of Consumption £01
2 725
12 462
838
Amb services
78%
Day Hosp
5%
Ful Hosp
0%Drugs
17%
2 725
12 462
838
16 026 £
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ISPOR - 11/13 Nov. 2001 PL-2238/01 27
10 Years Cost for relapsing
Patient by Type of Consumption £01
2 725
12 462
838
Amb services
11%Day Hosp
1%
Ful Hosp
87%
Drugs
17%
44 440
4075 370
50 577 £
360
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ISPOR - 11/13 Nov. 2001 PL-2238/01 28
The Overall 10 Years Cost of the
Schizophrenic Population £01
£ 9,3 milliards
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ISPOR - 11/13 Nov. 2001 PL-2238/01 29
Projected Life Years Cost
per Patient by Clinical State £01
Cohorte Olanzapine Risperidone Sertindole Others
Relapse 78 966 72 041 71 563 76 395
Non-relapse 22 273 24 014 23 854 22 639
TOTAL 101 239 96 055 95 417 99 034
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ISPOR - 11/13 Nov. 2001 PL-2238/01 30
Overall Life Years Cost
per Patient £01
Drugs Market share % Weighted cost
Olanzapine 33.38 33 792
Risperidone 28.31 27 195
Sertindole 12.32 11 751
Others 25.99 25 743
Total 100 98 481
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ISPOR - 11/13 Nov. 2001 PL-2238/01 31
The Overall Life Time Cost of the
Schizophrenic Population £01
£ 13,6 milliards
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Incremental Cost Effectiveness
Ratio for UK
Strategy Cost Marginal
Cost Effectiveness
Marginal
Effectiveness ΔC/ΔE
Sertindole 64 472 8.0520 8 006
Risperidone 64 911 439 7.9466 - 0.1055 8 168 Dominated
Haloperidol 68 499 4 027 6.7176 - 1.3344 10 197 Dominated
Olanzapine 68 541 4 069 7.3069 - 7.3069 9 380 Dominated
Cost £ 01 – Effectiveness : semesters without relapse – Time window : 10 years
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ISPOR - 11/13 Nov. 2001 PL-2238/01 33
Sensitivity Analysis
▪ Varying toxicity rates
▪ Varying compliance rates
▪ Varying relapse rates
▪ Varying hospitalisation rates
▪ Varying intensive home management rates
▪ Varying incremental costs between relapsers
and non-relapsers
▪ Varying discounting rate
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CONCLUSION
▪ Although sertindole demonstrates a better cost-effectiveness ratio than other typical or atypicalantipsychotics,
▪ The outcomes are modest and question the decisionmaking process on the sole basis of cost effectivenessanalysis.
▪ It seems quite difficult on the current available data todefine tight recommendations on which antipsychoticshould be recommended as first line treatment.