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UK cost-consequence analysis of aripiprazole in schizophrenia: diabetes and coronary heart disease risk projections (STAR study)

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Abstract

Patients with schizophrenia experience elevated rates of morbidity and mortality, largely due to an increased incidence of cardiovascular disease and diabetes. There is increasing concern that some atypical antipsychotic therapies are associated with adverse metabolic symptoms, such as weight gain, dyslipidaemia and glucose dysregulation. These metabolic symptoms may further increase the risk of coronary heart disease (CHD) and diabetes in this population and, subsequently, the cost of treating these patients’ physical health. The STAR study showed that the metabolic side effects of aripiprazole treatment are less than that experienced by those receiving standard-of-care (SOC). In a follow-up study the projected risks for diabetes or CHD, calculated using the Stern and Framingham models, were lower in the aripiprazole treatment group. Assuming the risk of diabetes onset/CHD events remained linear over 10 years, these risks were used to estimate the difference in direct and indirect cost consequences of diabetes and CHD in schizophrenia patients treated with aripiprazole or SOC over a 10-year period. Diabetes costs were estimated from the UKPDS and UK T2ARDIS studies, respectively, and CHD costs were estimated using prevalence data from the Health Survey of England and the published literature. All costs were inflated to 2007 costs using the NHS pay and prices index. The number of avoided diabetes cases (23.4 cases per 1,000 treated patients) in patients treated with aripiprazole compared with SOC was associated with estimated total (direct and indirect) cost savings of £37,261,293 over 10 years for the UK population. Similarly, the number of avoided CHD events (3.7 events per 1,000 treated patients) was associated with estimated total cost savings of £7,506,770 over 10 years. Compared with SOC, aripiprazole treatment may provide reductions in the health and economic burden to schizophrenia patients and health care services in the UK as a result of its favourable metabolic profile.

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References

  1. American Diabetes Association (2004) Consensus development conference on antipsychotic drugs and obesity and diabetes (American Diabetes Association; American Psychiatric Association; American Association of Clinical Endocrinologists; North American Association for the Study of Obesity). Diabetes Care 27:596–601

    Article  Google Scholar 

  2. American Diabetes Association (2004) Consensus development conference on antipsychotic drugs and obesity and diabetes (American Diabetes Association; American Psychiatric Association; American Association of Clinical Endocrinologists; North American Association for the Study of Obesity). J Clin Psychiatry 65:267–272

    Article  Google Scholar 

  3. Blonde L, Kan HJ, Gutterman EM, L’Italien GJ, Kim MS, Hanssens L, McQuade RD (2008) Predicted risk of diabetes and coronary heart disease in patients with schizophrenia: aripiprazole versus standard of care. J Clin Psychiatry 69:741–748

    PubMed  Google Scholar 

  4. Bobes J, Arango C, Aranda P, Carmena R, Garcia-Garcia M, Rejas J (2007) Cardiovascular and metabolic risk in outpatients with schizophrenia treated with antipsychotics: results of the CLAMORS Study. Schizophr Res 90:162–173

    Article  PubMed  Google Scholar 

  5. Brown S (1997) Excess mortality of schizophrenia. A meta-analysis. Br J Psychiatry 171:502–508

    Article  PubMed  CAS  Google Scholar 

  6. Brown S, Inskip H, Barraclough B (2000) Causes of the excess mortality of schizophrenia. Br J Psychiatry 177:212–217

    Article  PubMed  CAS  Google Scholar 

  7. Cassidy F, Ahearn E, Carroll BJ (1999) Elevated frequency of diabetes mellitus in hospitalized manic-depressive patients. Am J Psychiatry 156:1417–1420

    PubMed  CAS  Google Scholar 

  8. Chrzanowski WK, Marcus RN, Torbeyns A, Nyilas M, McQuade RD (2006) Effectiveness of long-term aripiprazole therapy in patients with acutely relapsing or chronic, stable schizophrenia: a 52-week, open-label comparison with olanzapine. Psychopharmacology (Berl) 189:259–266

    Article  CAS  Google Scholar 

  9. Clarke P, Gray A, Legood R, Briggs A, Holman R (2003) The impact of diabetes-related complications on healthcare costs: results from the United Kingdom Prospective Diabetes Study (UKPDS Study No. 65). Diabet Med 20:442–450

    Article  PubMed  CAS  Google Scholar 

  10. Curtis L, Netten A (2006) Unit costs of health and social care. Personal Social Services Research Unit, Canterbury

    Google Scholar 

  11. De Hert MA, van Winkel R, Van Eyck D, Hanssens L, Wampers M, Scheen A, Peuskens J (2006) Prevalence of the metabolic syndrome in patients with schizophrenia treated with antipsychotic medication. Schizophr Res 83:87–93

    Article  PubMed  Google Scholar 

  12. Gianfrancesco F, Pesa J, Wang RH, Nasrallah H (2006) Assessment of antipsychotic-related risk of diabetes mellitus in a Medicaid psychosis population: sensitivity to study design. Am J Health Syst Pharm 63:431–441

    Article  PubMed  Google Scholar 

  13. Goff DC, Sullivan LM, McEvoy JP, Meyer JM, Nasrallah HA, Daumit GL, Lamberti S, D’Agostino RB, Stroup TS, Davis S, Lieberman JA (2005) A comparison of ten-year cardiac risk estimates in schizophrenia patients from the CATIE study and matched controls. Schizophr Res 80:45–53

    Article  PubMed  Google Scholar 

  14. Haro JM, Salvador-Carulla L (2006) The SOHO (Schizophrenia Outpatient Health Outcome) study: implications for the treatment of schizophrenia. CNS Drugs 20:293–301

    Article  PubMed  CAS  Google Scholar 

  15. Hennekens CH, Hennekens AR, Hollar D, Casey DE (2005) Schizophrenia and increased risks of cardiovascular disease. Am Heart J 150:1115–1121

    Article  PubMed  Google Scholar 

  16. Henriksson F, Agardh CD, Berne C, Bolinder J, Lönnqvist F, Stenström P, Ostenson CG, Jönsson B (2000) Direct medical costs for patients with type 2 diabetes in Sweden. J Intern Med 248:387–396

    Article  PubMed  CAS  Google Scholar 

  17. Holmes J, Gear E, Bottomley J, Gillam S, Murphy M, Williams R (2003) Do people with type 2 diabetes and their carers lose income? (T2ARDIS-4). Health Policy 64:291–296

    Article  PubMed  Google Scholar 

  18. Jin H, Meyer JM, Jeste DV (2004) Atypical antipsychotics and glucose dysregulation: a systematic review. Schizophr Res 71:195–212

    Article  PubMed  Google Scholar 

  19. Jones PB, Barnes TR, Davies L, Dunn G, Lloyd H, Hayhurst KP, Murray RM, Markwick A, Lewis SW (2006) Randomized controlled trial of the effect on quality of life of second- vs first-generation antipsychotic drugs in schizophrenia: Cost Utility of the Latest Antipsychotic drugs in Schizophrenia Study (CUtLASS 1). Arch Gen Psychiatry 63:1079–1087

    Article  PubMed  CAS  Google Scholar 

  20. Jönsson B (2002) Revealing the cost of Type II diabetes in Europe. Diabetologia 45:S5–S12

    Article  PubMed  Google Scholar 

  21. Kelly C, McCreadie RG (1999) Smoking habits, current symptoms, and premorbid characteristics of schizophrenic patients in Nithsdale, Scotland. Am J Psychiatry 156:1751–1757

    PubMed  CAS  Google Scholar 

  22. Kerwin R, Millet B, Herman E, Banki CM, Lublin H, Pans M, Hanssens L, L’Italien G, McQuade RD, Beuzen JN (2007) A multicentre, randomized, naturalistic, open-label study between aripiprazole and standard of care in the management of community-treated schizophrenic patients Schizophrenia Trial of Aripiprazole: (STAR) study. Eur Psychiatry 22:433–443

    Article  PubMed  Google Scholar 

  23. Knapp M, King D, Pugner K, Lapuerta P (2004) Non-adherence to antipsychotic medication regimens: associations with resource use and costs. Br J Psychiatry 184:509–516

    Article  PubMed  Google Scholar 

  24. Knapp M, Mangalore R, Simon J (2004) The global costs of schizophrenia. Schizophr Bull 30:279–293

    PubMed  Google Scholar 

  25. L’Italien GJ, Casey DE, Kan HJ, Carson WH, Marcus RN (2007) Comparison of metabolic syndrome incidence among schizophrenia patients treated with aripiprazole versus olanzapine or placebo. J Clin Psychiatry 68:1510–1516

    Article  PubMed  Google Scholar 

  26. Leslie DL, Rosenheck RA (2005) Pharmacotherapy and health care costs among patients with schizophrenia and newly diagnosed diabetes. Psychiatr Serv 56:803–809

    Article  PubMed  Google Scholar 

  27. Lieberman JA (2004) Dopamine partial agonists: a new class of antipsychotic. CNS Drugs 18:251–267

    Article  PubMed  CAS  Google Scholar 

  28. Lieberman JA, Stroup TS, McEvoy JP, Swartz MS, Rosenheck RA, Perkins DO, Keefe RS, Davis SM, Davis CE, Lebowitz BD, Severe J, Hsiao JK (2005) Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 353:1209–1223

    Article  PubMed  CAS  Google Scholar 

  29. Luengo-Fernández R, Leal J, Gray A, Petersen S, Rayner M (2006) Cost of cardiovascular diseases in the United Kingdom. Heart 92:1384–1389

    Article  PubMed  Google Scholar 

  30. McEvoy JP, Meyer JM, Goff DC, Nasrallah HA, Davis SM, Sullivan L, Meltzer HY, Hsiao J, Scott Stroup T, Lieberman JA (2005) Prevalence of the metabolic syndrome in patients with schizophrenia: baseline results from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial and comparison with national estimates from NHANES III. Schizophr Res 80:19–32

    Article  PubMed  Google Scholar 

  31. McQuade RD, Stock E, Marcus R, Jody D, Gharbia NA, Vanveggel S, Archibald D, Carson WH (2004) A comparison of weight change during treatment with olanzapine or aripiprazole: results from a randomized, double-blind study. J Clin Psychiatry 65(Suppl 18):47–56

    PubMed  CAS  Google Scholar 

  32. National Institute for Clinical Excellence (2006) CG38 Bipolar disorder: NICE guideline. Available at http://www.nice.org.uk/page.aspx?o=cg38niceguideline. Accessed 5 April 2007

    Google Scholar 

  33. National Institute for Clinical Excellence (2002) Guidance on the use of newer (atypical) antipsychotic drugs for the treatment of schizophrenia. In: Technology appraisal No. 43. London

  34. National Institute for Clinical Excellence (2004) Guide to the methods of technology appraisal. In: National Institute for Clinical Excellence, London

  35. National Institute of Clinical Excellence (2003) Schizophrenia: full national clinical guideline on core interventions in primary and secondary care. In: National Institute of Clinical Excellence

  36. Newman SC, Bland RC (1991) Mortality in a cohort of patients with schizophrenia: a record linkage study. Can J Psychiatry 36:239–245

    PubMed  CAS  Google Scholar 

  37. Osborn DP, Levy G, Nazareth I, Petersen I, Islam A, King MB (2007) Relative risk of cardiovascular and cancer mortality in people with severe mental illness from the United Kingdom’s General Practice Rsearch Database. Arch Gen Psychiatry 64:242–249

    Article  PubMed  Google Scholar 

  38. Osiri M, Suarez-Almazor ME, Wells GA, Robinson V, Tugwell P (2003) Number needed to treat (NNT): implication in rheumatology clinical practice. Ann Rheum Dis 62:316–321

    Article  PubMed  CAS  Google Scholar 

  39. Potkin SG, Saha AR, Kujawa MJ, Carson WH, Ali M, Stock E, Stringfellow J, Ingenito G, Marder SR (2003) Aripiprazole, an antipsychotic with a novel mechanism of action, and risperidone vs placebo in patients with schizophrenia and schizoaffective disorder. Arch Gen Psychiatry 60:681–690

    Article  PubMed  CAS  Google Scholar 

  40. Primatesta P (2004) Health survey for England 2003. In: Sproston K, Primatesta P (eds) The Stationary Office, Norwich, UK

  41. Rascati KL, Johnsrud MT, Crismon ML, Lage MJ, Barber BL (2003) Olanzapine versus risperidone in the treatment of schizophrenia: a comparison of costs among Texas Medicaid recipients. Pharmacoeconomics 21:683–697

    Article  PubMed  Google Scholar 

  42. Rosenheck R, Cramer J, Allan E, Erdos J, Frisman LK, Xu W, Thomas J, Henderson W, Charney D (1999) Cost-effectiveness of clozapine in patients with high and low levels of hospital use. Department of Veterans Affairs Cooperative Study Group on Clozapine in Refractory Schizophrenia. Arch Gen Psychiatry 56:565–572

    Article  PubMed  CAS  Google Scholar 

  43. Rosenheck R, Cramer J, Xu W, Grabowski J, Douyon R, Thomas J, Henderson W, Charney D (1998) Multiple outcome assessment in a study of the cost-effectiveness of clozapine in the treatment of refractory schizophrenia. Department of Veterans Affairs Cooperative Study Group on Clozapine in Refractory Schizophrenia. Health Serv Res 33:1237–1261

    PubMed  CAS  Google Scholar 

  44. Stern MP, Williams K, Haffner SM (2002) Identification of persons at high risk for type 2 diabetes mellitus: do we need the oral glucose tolerance test? Ann Intern Med 136:575–581

    PubMed  Google Scholar 

  45. Tandon R, Marcus RN, Stock EG, Riera LC, Kostic D, Pans M, McQuade RD, Nyilas M, Iwamoto T, Crandall DT (2006) A prospective, multicenter, randomized, parallel-group, open-label study of aripiprazole in the management of patients with schizophrenia or schizoaffective disorder in general psychiatric practice: Broad Effectiveness Trial with Aripiprazole (BETA). Schizophr Res 84:77–89

    Article  PubMed  Google Scholar 

  46. Wilson PW, D’Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB (1998) Prediction of coronary heart disease using risk factor categories. Circulation 97:1837–1847

    PubMed  CAS  Google Scholar 

  47. Zethraeus N, Molin T, Henriksson P, Jönsson B (1999) Costs of coronary heart disease and stroke: the case of Sweden. J Intern Med 246:151–159

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

The authors wish to thank Michelle Seymour, PhD (Envision Pharma, Horsham, UK) for assistance with the development of this paper. Additional support for the preparation of this manuscript was provided by Ogilvy Healthworld Medical Education; funding was provided by Bristol-Myers Squibb Company.

Conflict of interest

AB has received honoraria for lectures relevant to this area from Bristol-Myers Squibb, Otsuka, Sanofi-Aventis and AstraZeneca. HM has received honoraria for lecturing and advisory work from Bristol-Myers Squibb, Otsuka, Janssen-Cilag and Wyeth. JYL is an employee of Otsuka Pharmaceuticals. GI and MVB are employees of Bristol-Myers Squibb. MK has received financial support for undertaking research, lecturing, and advisory work from Eli Lilly, Bristol-Myers Squibb, Organon and the Department of Health for England.

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Authors and Affiliations

  1. Undergraduate Centre, Heart of England NHS Foundation Trust, Birmingham, B9 5SS, UK

    Anthony H. Barnett

  2. Tayside Primary Care Division, Carseview Centre, Dundee, Scotland, UK

    Helen L. Millar

  3. Otsuka Pharmaceuticals, Paris, France

    Jean-Yves Loze

  4. Bristol-Myers Squibb Co., Wallingford, CT, USA

    Gilbert J. l’Italien

  5. School of Medicine, Yale University, New Haven, CT, USA

    Gilbert J. l’Italien

  6. Bristol-Myers Squibb Co., Braine l’Alleud, Belgium

    Marc van Baardewijk

  7. London School of Economics and Political Science and Institute of Psychiatry, King’s College, London, UK

    Martin Knapp

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  1. Anthony H. Barnett
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Correspondence to Anthony H. Barnett.

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Barnett, A.H., Millar, H.L., Loze, JY. et al. UK cost-consequence analysis of aripiprazole in schizophrenia: diabetes and coronary heart disease risk projections (STAR study). Eur Arch Psychiatry Clin Neurosci 259, 239–247 (2009). https://doi.org/10.1007/s00406-008-0863-2

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