Analisi di costo-utilità probabilistica di lurasidone rispetto allo standard di cura in pazienti con schizofrenia in Italia.

Background: Schizophrenia is a psychotic disorder, con- sidered among the most serious and debilitating mental dis- orders. Lurasidone belongs to a group of medicines called antipsychotics and is indicated for the treatment of schizo- phrenia in adults from 18 years of age. Objective: The aim of this study was to evaluate costs and outcomes generated using lurasidone compared to the sec- ond-generation antipsychotics currently used in Italy for the treatment of adult patients with schizophrenia. Methods: A decision tree with a 1-year follow-up was de- veloped from the National Service Perspective (NHS). Hos- pitalization risk for each treatment and the utility estimates associated with each health state have been obtained from the literature. Hospitalization costs were estimated through the national tariffs associated with DRGs, while the costs of drugs were obtained from regional bargaining tenders for the Standard of Care (SoC) and using the market price (net of non-transparent discounts) for lurasidone. A determinis- tic and a probabilistic sensitivity analysis were conducted to evaluate parameter uncertainty. Results: The model estimated a total annual cost of € 68,413.7 per 100 patients treated with lurasidone (approxi- mately 70% related to the hospitalization cost) and a total annual cost of € 50,966.9 per 100 patients treated with SoC. The total QALYs obtained were lower for patients treated with SoC compared to lurasidone (74.5 vs 75.3 respective- ly). The incremental cost-effectiveness ratio (ICER) was estimated at € 22,552.7 per QALY. The Monte Carlo simu- lations showed that with a maximum threshold for the will- ingness to pay of € 40,000 per QALY, the probability of cost-effectiveness of lurasidone was approximately 71%. Conclusions: The deterministic results showed that lurasi- done could be a cost-effective treatment option compared to SoC considering a minimum threshold for the willingness to pay of € 25,000 per QALY gained. Taking into account the intrinsic variability of the parameters included in the model, the probability of cost-effectiveness of lurasidone was high- er than 55% and 70% considering a threshold for the will- ingness to pay of € 25,000 and € 40,000 per QALY gained respectively.