Inpharma 1636 - 3 May 2008

Pharmacoeconomic news from AMCPSan Francisco, California, US April 2008

This article highlights a selection of studies presented Risperidone long-acting injectable pans outat the 20th Annual Meeting and Showcase for the Risperidone long-acting injectable use may lead toAcademy of Managed Care Pharmacy (AMCP), held in fewer days of relapse and hospitalisation amongApril in San Francisco, California, US. schizophrenia patients, "especially in patients for whom

compliance is a challenge", say US-based researchers.4Rosiglitazone use declines in the USThese improved clinical outcomes "may translate intoRosiglitazone use has decreased by 58% since May

overall medical cost savings", suggest the researchers2007, after a meta-analysis found an association[see table]. A decision-analysis model was constructedbetween the drug and an increased risk of ischaemicusing data obtained from published medical literature,heart disease events, say US-based researchers.1

unpublished clinical trial and administrative claims dataHowever, "rosiglitazone users do not appear to haveand clinical expert opinion. Model outcomes includedshifted to pioglitazone", they add. Trend data obtainedpercentage, number and duration of relapses per patientfrom ten independent commercial Blue Cross Blueper year and direct medical costs.Shield plans with a combined membership of 9 million

were analysed from January to October 2007. In January2007, rosiglitazone claims per day per million members Costs and outcomes for schizophrenia treatmenttotalled 72, versus 93 for pioglitazone. Rosiglitazone use Costs and Risperidone Oral Haloperidolwas flat from January to April, declined by 58% over the outcomes long- atypical decanoatenext 4 months, and then stabilised at 30 claims per day acting antipsychoticsa

injectableper million members in September and October.Pioglitazone use rose 6% from May to June, and then Mean days of 3 15 18

hospitalisation perremained flat to October, at 99 claims per day perpatient per yearmillion members. At present, > 1 of 4 rosiglitazone

Mean days of 1 5 6users are at increased risk for a future cardiovascularrelapse notevent (due to risk factors or cardiovascular disease), and requiring

health insurers "may wish to require prior authorization hospitalisationor remove rosiglitazone from their formulary", the Total costs ($US) 17 276 20 759 21 231researchers suggest.

a weighted outcomes for paliperidone ER, risperidone, olanzapine,quetiapine, ziprasidone and aripiprazole by market shareEVIDENCE that SC IFN-β-1a might be worth it

The EVIDENCE study showed SC administration ofinterferon (IFN)-β-1a to result in a greater number of Aliskiren "may be cost effective"relapse-free multiple sclerosis patients than IM Aliskiren therapy "may be cost effective" for patientsadministration. The incremental costs of such with hypertension, type 2 diabetes, and nephropathyadministration "need to be balanced against the with residual proteinuria, given the additional renalimproved efficacy" observed, according to protection it affords, suggest researchers from the US.5investigators from the US.2

They used a Markov model to project the costs andThey used a discrete event simulation model to outcomes of adding aliskiren to losartan and optimalsimulate the potential longer-term clinical and economic antihypertensive therapy among such patients over aimplications of the EVIDENCE trial, based on two 20-year period. According to the model, the addition ofhypothetical cohorts receiving either SC IFN-β-1a or IM aliskiren would increase costs by $US2454 per patient,IFN-β-1a. reflecting the increased pharmacy costs of aliskiren andBased on 100 replications of 1000 patient pairs over losartan; these costs would be "partially offset" by4 years, SC administration was predicted to allow more $US4888 in costs savings from avoidance of end-stagepatients to be relapse-free than IM administration (216 renal disease and transplantation. Aliskiren would costvs 147), at an incremental cost of $US10 616 per relapse an additional $US26 957 per QALY, versus losartanprevented, and $US229 per relapse-free day gained. and optimal antihypertensive therapy alone, which isPegfilgrastim proves its worth "below the generally acceptable range in the U.S."

Primary prophylaxis against neutropenia using ($US50 000–$US100 000/QALY), note the researchers.pegfilgrastim is cost effective, compared with 6-day Infliximab use initiates high costs in RAfilgrastim in women receiving chemotherapy for Patients initiating rheumatoid arthritis (RA) treatmentstage I–III breast cancer. This is the conclusion reached with infliximab incurred "significantly greater annualby US-based researchers in their modelling study, medical costs" than those initiating treatment withconducted from the perspective of the US health payer.3

etanercept or adalimumab, US-based researchersWhen simulated over a lifetime, the model projected conclude.6total costs to be $US9529 and $US9065 per patient for Data for a large, geographically diverse RA populationpegfilgrastim and 6-day filgrastim, respectively. naive to anti-tumour necrosis factor (TNF) therapiesIncluding the effect of chemotherapy relative dose were analysed for 633 patients initiating infliximabintensity on long-term survival yielded an ICER of therapy, 1181 patients initiating etanercept therapy and$US4746 per QALY gained for pegfilgrastim versus 568 initiating adalimumab therapy. Mean annual anti-6-day filgrastim. ICERs did not exceed $US100 000/ TNF costs (2005 values, adjusted for baselineQALY when key factors were varied within "plausible differences) were 28–29% greater for infliximabranges", note the researchers. recipients than for etanercept and adalimumab

recipients (p < 0.001).

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Inpharma 3 May 2008 No. 16361173-8324/10/1636-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

Single Article

1. Gleason PP, et al. Pioglitazone and rosiglitazone 2007 utilization trends and 4. Edwards NC, et al. Cost-effectiveness evaluation of risperidone long-actingprevalence of cardiovascular risk among rosiglitazone users. Journal of Managed injectable. Journal of Managed Care Pharmacy 14: 214, No. 2, Mar 2008.Care Pharmacy 14: 241, No. 2, Mar 2008. 5. Delea TE, et al. Cost-effectiveness of aliskiren in addition to losartan and

2. AL-Sabbagh AM, et al. Pharmacoeconomic modeling of the health benefits and optimal antihypertensive therapy in patients with hypertension and diabeticeconomic impact of treating relapsing forms of multiple sclerosis with nephropathy: a U.S. health care system perspective. Journal of Managed Caresubcutaneous versus intramuscular interferon beta-1A. Journal of Managed Care Pharmacy 14: 214-215, No. 2, Mar 2008.Pharmacy 14: 240, No. 2, Mar 2008. 6. Ollendorf D, et al. Cost differences between TNF-antagonist therapies for

3. Masaquel A, et al. Cost-effectiveness of primary prophylaxis with pegfilgrastim rheumatoid arthritis in a managed care population. Journal of Managed Careversus 6-day filgrastim in women with early-stage breast cancer receiving Pharmacy 14: 213-214, No. 2, Mar 2008.chemotherapy. Journal of Managed Care Pharmacy 14: 215, No. 2, Mar 2008. 801099168

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