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. 2014 Aug;31(8):873-90.
doi: 10.1007/s12325-014-0139-3. Epub 2014 Jul 24.

Cost-effectiveness of asenapine in the treatment of patients with bipolar I disorder with mixed episodes in an Italian context

Chiara Caresano  1 , Guido Di Sciascio, Andrea Fagiolini, Giuseppe Maina, Giulio Perugi, Claudio Ripellino, Claudio Vampini
Affiliations

Cost-effectiveness of asenapine in the treatment of patients with bipolar I disorder with mixed episodes in an Italian context

Chiara Caresano et al. Adv Ther. 2014 Aug.

Abstract

Introduction: Bipolar disorder is a chronic disease characterized by periods of mania or hypomania, depression, or a combination of both (mixed state). Because bipolar disorder is one of the leading causes of disability, it represents an important economic burden on society. Asenapine (ASE) is a new second-generation antipsychotic developed and approved for the treatment of manic or mixed episodes associated with bipolar disorder. The objective of the present study was to assess the cost-effectiveness of ASE compared to olanzapine (OLA) in the treatment of patients experiencing mixed episodes associated with bipolar I disorder in the context of the Italian National Health Service (NHS).

Methods: A pharmacoeconomic model was developed to simulate the management of Italian bipolar I patients with mixed episodes over a 5-year time horizon by combining clinical parameters with resource utilization. An expert panel of Italian psychiatrists and health economists was responsible for adapting a UK model to the Italian context. The primary outcome measure of the economic evaluation was the incremental cost effectiveness ratio, where effectiveness is measured in terms of quality adjusted life-years gained. Scenario analyses, sensitivity analyses, and a probabilistic sensitivity analysis were performed to test the robustness of the model.

Results: This pharmacoeconomic model showed that ASE resulted to be dominant over OLA; in fact, ASE was associated with lower direct costs (derived largely by the savings from hospitalizations avoided) and also generated a better quality of life. Results were robust to changes in key parameters; both scenario analyses and sensitivity analyses demonstrated model reliability.

Conclusions: Results from this study suggest that the management of bipolar I patients with mixed episodes using ASE as alternative to OLA can lead to cost saving for the Italian NHS and improve patients quality of life.

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Figures

Fig. 1
Fig. 1
Acute phase model structure
Fig. 2
Fig. 2
Maintenance phase model structure. TX treatment, AA atypical antipsychotic
Fig. 3
Fig. 3
PSA Scatter plot on cost-effectiveness plane for treatment with ASE versus OLA. ASE asenapine, OLA olanzapine, PSA probabilistic sensitivity analysis, QALYs quality-adjusted life years
See this image and copyright information in PMC

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