ArticlePloS one2025
Cost-utility of aripiprazole once-monthly versus paliperidone palmitate once-monthly injectable for schizophrenia in China.
Article in PloS one, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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6 authors.
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Abstract
objectivesFrom the perspective of Chinese healthcare system, this study compared the cost-utility of aripiprazole once-monthly (AOM) and paliperidone palmitate once-monthly injectable (PP1M) in the treatment of adult patients with schizophrenia in China.
methodsA 5-state Markov model was developed to evaluate the cost-utility of 10 years of long-acting injections (LAI) treatment for schizophrenia. The long-term costs and quality-adjusted life years (QALYs) were estimated, with the incremental cost-effectiveness ratio (ICER) as the primary outcome. The annual discount rate was set at 5%. A cost-effectiveness threshold (CET) of 0.51 times China's 2023 gross domestic product (GDP) (US$ 6,394.536) was used to judge the economics of intervention.
resultsThe current price of AOM in China is relatively high (US$418.140). To assess its cost-effectiveness in the context of potential price negotiations with China Healthcare Security Administration (CHS) for inclusion in the National Reimbursement Drug List (NRDL), we simulated a 40% price reduction (US$257.619). At a CET of 0.51 times GDP per capita (US$6,394.536), the base-case analysis showed that the incremental costs of AOM relative to PP1M after 10 years of treatment were US$1,926.373 with an incremental gain of 0.306 QALYs. The ICER for AOM was US$6,285.303 per QALY, which is below the CET, indicating that AOM is cost-effective. One-way sensitivity analysis identified AOM's drug cost as the parameter with the greatest impact on results. Probabilistic sensitivity analysis revealed that with a 40% price reduction, the probability of AOM being cost-effective is only 41.70%. However, with a 60% price reduction, AOM became dominantly cost-effective, with the probability increasing to 100%. When the CET was relaxed to 0.90 times GDP per capita (US$11,284.476), the probability of cost-effectiveness for AOM after a 40% price reduction rose to 85.10%. Scenario analyses conducted over a time horizon extending from 10 to 30 years showed that the ICER decreased significantly with longer follow-up, gradually approaching the 0.51GDP threshold and remaining below the 0.90 GDP threshold throughout the analysis.
conclusionsThe cost-effectiveness of AOM relative to PP1M is highly influenced by its price and the CET. Healthcare decision makers or clinical users need to balance innovation incentives and accessibility.
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