A Pharmacoeconomic analysis of compliance gains on

Authors: Joep Damen PerOlof Thuresson Bart Heeg Mickael Lothgren

Publish Date: 2012/08/06

Volume: 6, Issue: 4, Pages: 189-197

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Abstract

Compliance among patients with schizophrenia is typically poor Consequently treatments that are equally efficacious under trialbased conditions but face different compliance rates in clinical practice eg due to adverseeffect profile ease of use reputation may have differences in effectiveness not observed during trials This study analyses the impact of differences in compliance with atypical antipsychotics using a pharmacoeconomic discreteevent simulation DES model adapted to the Swedish treatment settingThe two treatment arms were identical except for percentage of compliant patients Noncompliant patients experienced shorter time between relapses and had inferior symptom control than their compliant counterparts The difference in compliance rates was varied from 0 to 15 and incremental costs and effects were recorded and analysedWith a 5 10 and 15 difference in compliance rate incremental effects increased to 0021 0037 and 0062 respectively while generating cost savings of Swedish kronor SEK31 500 SEK62 000 and SEK104 500 respectively SEK925 = €1 year 2007 values Hence each percentage point of compliance gain is predicted to roughly result in a cost saving of SEK6000 and a QALY gain of 0004 On average the model predicts that with a 15 increase in compliance 05 relapses are prevented the average Positive And Negative Syndrome Scale PANSS score decreases by 33 points and patients spend 22 fewer days in hospital over 5 yearsThe DES model predicts that increases in compliance may lead to considerable cost savings and health improvements Therefore when determining the cost effectiveness of a new antipsychotic efficacy rates from clinical trials should not be taken at face value but should be interpreted in tandem with expectations concerning compliance in light of product characteristics such as adverse effects These results further suggest that efforts to improve compliance among patients with schizophrenia are expected to prove cost effective if compliance gains and the resulting health improvements and cost savings are in balance with the additional costs

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