ArticleJournal of managed care & specialty pharmacy2026
Cost-effectiveness analysis of treatment strategies initiating with second-generation antipsychotic long-acting injectables in patients with schizophrenia in the United States.
Article in Journal of managed care & specialty pharmacy, 2026. 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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Abstract
backgroundSchizophrenia is associated with high treatment nonadherence and economic burden in the United States. Long-acting injectable (LAI) antipsychotics may improve adherence and reduce relapse risk, but comparative cost-effectiveness data of second-generation antipsychotic (SGA) LAIs in the United States remain limited.
objectiveTo compare the cost-effectiveness of treatment strategies initiating with 4 SGA LAIs, aripiprazole monohydrate, aripiprazole lauroxil, olanzapine pamoate, and risperidone, with the strategy initiating with monthly paliperidone palmitate in patients with schizophrenia from the US health care sector perspective.
methodsA Markov model with 90-day cycles was developed to simulate the progression of 40-year-old adults transitioning among stable treated, stable nontreated, and relapse health states and death over 5 years at a 3% discount rate. Patients transitioned to additional lines of therapy (another SGA LAI and then clozapine) after relapse or intolerance to side effects. Transition probabilities were derived from US claims-based observational studies, clinical trials, and meta-analyses. Health state utilities and disutilities due to extrapyramidal symptoms, weight gain, and diabetes from published literature were applied to age-adjusted utility of the US population.
resultsCompared with the treatment strategy initiating with paliperidone (3.22 quality-adjusted life-years [QALYs]), treatment strategies initiating with the other SGA LAIs generated slightly lower to similar QALYs. Strategies initiating with aripiprazole monohydrate and risperidone were dominated by the paliperidone-initiating strategy. Strategies initiating with aripiprazole lauroxil and olanzapine resulted in lower total health care costs but lower QALYs, with incremental cost-effectiveness ratios of $242,477 and $2,887, respectively. Sensitivity analysis confirmed the robustness of these findings, with LAI drug costs and relapse probabilities being the most influential parameters.
conclusionsOver a 5-year horizon, the treatment strategy initiating with paliperidone emerged as a favorable LAI option, providing the highest QALY gains at comparable or lower costs than the other LAI-initiating strategies.
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