Background To compare the costs and effects of paliperidone extended release (ER), a new pharmaceutical treatment for the management of schizophrenia, with the most frequently prescribed oral treatments in Greece (namely risperidone, olanzapine, quetiapine, aripiprazole and ziprasidone) over a 1-year time period.
Methods A decision tree was developed and tailored to the specific circumstances of the Greek healthcare system. Therapeutic effectiveness was defined as the annual number of stable days and the clinical data was collected from international clinical trials and published sources. The study population was patients who suffer from schizophrenia with acute exacerbation. During a consensus panel of 10 psychiatrists and 6 health economists, data were collected on the clinical practice and medical resource utilisation. Unit costs were derived from public sources and official reimbursement tariffs. For the comparators official retail prices were used. Since a price had not yet been granted for paliperidone ER at the time of the study, the conservative assumption of including the average of the highest targeted European prices was used, overestimating the price of paliperidone ER in Greece. The study was conducted from the perspective of the National Healthcare System.
Results The data indicate that paliperidone ER might offer an increased number of stable days (272.5 compared to 272.2 for olanzapine, 265.5 for risperidone, 260.7 for quetiapine, 260.5 for ziprasidone and 258.6 for aripiprazole) with a lower cost compared to the other therapies examined (€7,030 compared to €7,034 for olanzapine, €7,082 for risperidone, €8,321 for quetiapine, €7,713 for ziprasidone and €7,807 for aripiprazole). During the sensitivity analysis, a ± 10% change in the duration and frequency of relapses and the economic parameters did not lead to significant changes in the results.
Conclusion Treatment with paliperidone ER can lead to lower total cost and higher number of stable days in most of the cases examined.
At first glance, it seems fairly straightforward. Second-generation antipsychotics are expensive. There have been many studies on the cost-effectiveness. This one is fairly typical. Except for the timing.
You see, generic risperidone has just recently
become available, at least in the USA. Paliperidone is the
active metabolite of risperidone. Paliperidone does have some
advantages, but in general it is fairly comparable to risperidone.
The study shows that paliperidone may have a slight advantage in efficacy. Given that the cost cited for paliperidone is slightly lower than the cost cited for risperidone, it would follow paliperidone would be more cost-effective.
But what if they used today's costs?
At this moment, Drugstore.com lists Invega 9mg capsules, #100 for $1,638.95. (Invega in the brand name for paliperidone ER.) They list generic risperidone, #180, for $869.98. Typically a person would take one Invega 9mg capsule per day, or two 3mg risperidone per day. Using those figures, the treatment with Invega would cost $16.39 per day. Generic risperidone would cost $9.67 per day.
Usually, when a generic drug is first marketed, it comes out at a relatively small discount compared to the branded product. After about six months, the price tends to decline even more. So the price differential is going to increase pretty soon.
I suspect that the authors would arrive at a very different conclusion about the cost-effectiveness, if they were to run their models using updated cost figures.
Oh, and one of the authors of the paper works for Janssen, the maker of Invega. They also make Risperdal (the branded version of risperidone.) Janssen stands to lose market share, as Risperdal was one of the flagship products, and there is now a generic version. The generic risperidone will compete with their new product, Invega. It sure would be nice, for them, if they could show a convincing reason to prescribe the new product. Unfortunately, the study that showed an economic advantage was out of date almost as soon as it was published.
The study shows that paliperidone may have a slight advantage in efficacy. Given that the cost cited for paliperidone is slightly lower than the cost cited for risperidone, it would follow paliperidone would be more cost-effective.
But what if they used today's costs?
At this moment, Drugstore.com lists Invega 9mg capsules, #100 for $1,638.95. (Invega in the brand name for paliperidone ER.) They list generic risperidone, #180, for $869.98. Typically a person would take one Invega 9mg capsule per day, or two 3mg risperidone per day. Using those figures, the treatment with Invega would cost $16.39 per day. Generic risperidone would cost $9.67 per day.
Usually, when a generic drug is first marketed, it comes out at a relatively small discount compared to the branded product. After about six months, the price tends to decline even more. So the price differential is going to increase pretty soon.
I suspect that the authors would arrive at a very different conclusion about the cost-effectiveness, if they were to run their models using updated cost figures.
Oh, and one of the authors of the paper works for Janssen, the maker of Invega. They also make Risperdal (the branded version of risperidone.) Janssen stands to lose market share, as Risperdal was one of the flagship products, and there is now a generic version. The generic risperidone will compete with their new product, Invega. It sure would be nice, for them, if they could show a convincing reason to prescribe the new product. Unfortunately, the study that showed an economic advantage was out of date almost as soon as it was published.
Brain & Behavior
Comments
Spectacular post and an excellent analysis of pharma's marketing strategy--repackage the old and brand it as the new. Paliperidone is Janssen's attempt to keep their original product (risperidone) afloat and should not be given any special treatment. I've yet to see a follow-on drug of this nature (excluding levofloxacin [Levaquin]) that was truly superior to its parent.
Posted by: N.B. | October 6, 2008 10:57 PM
One might be able to make the case for Escitalopram vs Citalopram. Sometimes extended-release versions can have serious advantages over instant-release versions, especially with stimulants, where they're notoriously short-acting, or anti-convulsants where you absolutely want to keep levels stable.
Additionally, note that Paliperidone appeared to have a slightly greater performance in this study over Risperidone, implying that there might be some advantages to it. At the very least, it implies that some patients may receive a greater benefit from it, and leaving aside the potential discounts of generic risperidone, it still appears to show cost benefits over the other anti-psychotic drugs.
Posted by: Hyperion | October 7, 2008 2:34 AM