Cost-effectiveness analysis of xanomeline and trospium chloride for the treatment of adults with schizophrenia in the US.

AIM: The objective of this analysis was to evaluate the cost-effectiveness of xanomeline and trospium chloride (KarXT) as first line (1 L) treatment for adults with schizophrenia from a third-party US payer perspective compared with commonly used antipsychotics, considering both costs and patient quality of life.

METHODS

A decision tree-Markov hybrid approach was used to develop an economic model which included both acute and maintenance phases, accounting for probability of treatment response, discontinuation, relapse, adverse events, and death over a lifetime horizon. Clinical data were drawn from published trials, with costs and utilities coming from publicly available sources. Incremental cost-effectiveness ratios (ICERs) were calculated, and sensitivity and scenario analyses were performed to test the robustness of the results.

RESULTS

In the base case analysis, KarXT was found to be more costly but more effective than common generic antipsychotics, yielding cost-effective ICERs, and less costly and more effective than branded antipsychotics. The model was associated with moderate sensitivity to treatment response inputs. Scenario analyses showed that implementation of a societal perspective, no tardive dyskinesia risk for KarXT, and a 50% reduction KarXT's relapse probability improved the cost-effectiveness of KarXT. Conversely, a 50% increase in KarXT's relapse probability and a second line analysis worsened cost-effectiveness.

LIMITATIONS: At the time of the analysis, relapse data did not exist for KarXT therefore an average of other treatments was assumed and tested in a sensitivity analysis. Also, patients may receive multiple lines of therapy in a lifetime, however, the model only incorporated three lines of treatment.

CONCLUSIONS

KarXT, the first schizophrenia medication in 70 years with a non-dopaminergic mechanism of action, is a valuable and potentially cost-effective 1 L treatment option, highlighting the need for continued innovation in this disease space.