Objective: To compare the cost-effectiveness of lurasidone and quetiapine XR monotherapy in patients with bipolar I depression.
Methods: A cost-effectiveness model was developed to compare monotherapy with lurasidone to quetiapine XR over a 3-month time horizon from a US payer perspective. Effectiveness inputs were based on indirect comparison of the proportion of patients achieving remission (MADRS total score ≤12 by week 6-8), obtained from lurasidone and quetiapine XR pivotal trials versus placebo. Resource utilization (emergency room visits, hospitalizations, and office visits) for remission versus no remission were based on a study utilizing data from an expert panel. Drug costs were estimated using mean dose from clinical trials and wholesale acquisition costs. Costs of resources were obtained from a retrospective database study of bipolar I depression patients. Model results were tested using deterministic and probabilistic sensitivity analyses.
Results: Over the 3-month time horizon of the model, 52.0% of lurasidone patients achieved remission versus 43.2% of quetiapine XR patients. Mean emergency room visits, inpatient days, and office visits were lower for lurasidone patients (0.48, 2.1, 9.3) than quetiapine XR patients (0.50, 2.2, 9.6), respectively. Total costs were lower for lurasidone patients ($4,447) than quetiapine XR patients ($4,546). Cost-effectiveness analysis demonstrated lurasidone was dominant (more effective and less costly) over quetiapine XR. Model testing showed lurasidone was consistently cost-effective compared to quetiapine XR at a willingness-to-pay threshold of $5,000 per remission in 97.4% of simulations.
Conclusions: Based on this model, lurasidone is cost-effective compared to quetiapine XR in patients with bipolar I depression.