PMH26 Modeling Economic Consequences of Cardiometabolic Changes with Lurasidone Versus Other Atypical Antipsychotics in Schizophrenia

To assess the cost-consequences of cardiometabolic effects of lurasidone versus other atypical antipsychotics in adults with schizophrenia and compare the results based on published cardiovascular and diabetes risk equations from the Framingham Heart Study (FHS), the Atherosclerosis Risk in Communities study (ARIC), and the San Antonio Heart Study (SAHS). A discrete event simulation model was developed to simulate the economic outcomes based on cardiometabolic parameter changes after 1-year treatment. With a 3-year time horizon, the model predicted the number of: 1) incident diabetes cases using each of the risk equations, and 2) cardiovascular events (e.g., coronary heart disease (CHD), stroke) (CVD) based on updated cardiometabolic values at 1 year, and estimated the costs associated with each event. Data were drawn from comparative clinical trials of lurasidone for lurasidone, risperidone, and quetiapine, and from the literature for olanzapine. Cost data in 2011 values were obtained from public data sources and discounted at 3.5% annually. Compared with olanzapine, risperidone, and quetiapine, lurasidone: 1) avoided 119, 15, and 7 diabetes cases and saved $1708, $192, and $95 per patient, excluding the costs of antipsychotics and other events, respectively, when using FHS equation; 2) avoided 58, 8, and 0 diabetes cases and saved $1,036, $114, and $22 when using SAHS equation; and 3) avoided 52, 7, and 7 diabetes cases and saved $900, $76, and $88 when using ARIC equation. Incidence of other CVD events was low across all drugs in the model due to the short time-horizon. Lurasidone saved ≥$9600 per patient in all comparisons when costs of other CVD events and antipsychotics were included. In this analysis, lurasidone was a cost-saving option compared to other antipsychotics. Although the magnitude of cost savings with lurasidone differed based on the risk equation used, cost savings with lurasidone were consistently observed.