Cost-effectiveness of injectable atypical long-acting antipsychotics for chronic schizophrenia in Poland
Bibliographic record
Abstract
Objective: In order to determine the cost-effectiveness of paliperidone palmitate (PP-LAI), a long-acting injectable formulation, indicated for once-monthly injections as antipsychotic therapy, it was compared with risperidone, a long-acting, injectable (RLAI) and biweekly agent, administered for treatment of chronic schizophrenia in Poland, as perceived from the perspective of the National Health Fund (NHF). Methods: We adapted a 1-year decision tree model to the Polish healthcare system with literature-derived and clinical expert inputs. The compared drugs included PP-LAI, a new treatment option of antipsychotic therapy, and RLAI, the established treatment for Polish patients. Clinical rates were derived from published trials. Model outputs included expected cost per patient, as well as the rates of hospitalization, emergency room visits, days free of symptoms and quality-adjusted life-years (QALYs). One-way sensitivity analyses were applied to major inputs. All the inputs were also simultaneously varied in probabilistic sensitivity analyses. Results: Despite its higher acquisition cost, PP-LAI demonstrated a lower expected cost per treated patient. PP-LAI was associated with 0.824 QALYS, 323 days with stable disease and 44.6% hospitalization. RIS-LAI had 0.817 QALY, 317 stable days and 51.3% hospitalization. PP-LAI dominated RIS-LAI in the base case and in 55.0% of 10,000 simulations, and was cost-effective in 76.6%. However, the cost-effectiveness was sensitive, being lost with modest increases for PP-LAI or decreases for compared drugs with respect to their prices, relapse and adherence rates. Because it is injected monthly as opposed to biweekly, PP-LAI saves caregiver time as it is administered monthly, as opposed to the biweekly regimen. Conclusions: From the viewpoint of the National Health Fund of Poland, when compared with RLAI, PP-LAI is a cost-effective drug with potential to reduce healthcare expenses.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.010 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".