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Ganz ML, et al. J Med Econ. 2021; 24:103-113.
This study evaluated the clinical and economic outcomes associated with valbenazine compared with deutetrabenazine in patients with TD.
This study included 1000 patients with TD who were receiving antipsychotic medication for the treatment of the underlying psychiatric illness. Clinical inputs were derived from relevant clinical trials or publicly available sources. Patients were assessed over 1 year using ≥50% improvement from baseline in Abnormal Involuntary Movement Scale (AIMS) total score as the primary definition of response. Responses at 1 year using Clinical Global Impression of Change (CGIC) scores ≤2 were also assessed. Health outcomes included quality-adjusted life-years (QALYs), life-years, proportion responding to treatment at 1 year, and the number of psychiatric relapses.
Patients treated with valbenazine were more likely to have responded to treatment at 1 year, lived longer, and accrued more QALYs than patients who received deutetrabenazine. Using the AIMS response criterion, the incremental cost-effectiveness ratio was $9,951/QALY for valbenazine compared with deutetrabenazine. By comparison, using the CGIC response criterion, valbenazine dominated deutetrabenazine with valbenazine-treated patients, accumulating more QALYs (3.4 vs 3.3 years) and incurring lower lifetime costs ($252,311 vs $283,208) than deutetrabenazine-treated patients.
Both medications are FDA approved for treating TD. Valbenazine is highly cost-effective compared with deutetrabenazine for the treatment of TD.
Clinical Commentary (Sanjay Gupta, MD)
The indirect comparison based on treatment over 1 year used 3 outcome measures.
There are some significant limitations to be noted. The effects of adverse events on outcomes and costs were not included in the research. There are no head-to-head trials available, so the response was calculated based on an indirect treatment comparison of the results from individual trials of the 2 medications. Deutetrabenazine has data going past 1 year that were not included. Only direct costs such as drug acquisition costs and relapse treatment costs were included in the analysis.
Patient response outcomes, caregiver measures, quality-of-life questionnaires, and functional scales were not done, which may underestimate the value of VMAT2 inhibitors.
In my opinion, based on this indirect comparison study, valbenazine may be the preferred treatment option compared with deutetrabenazine based on cost and efficacy. Valbenazine also has a simple titration and ease of use (once daily), suggesting it to be a first-line medication for the treatment of TD.
Clinical Commentary (Joseph P. McEvoy, MD)
The authors conducted these analyses on a “synthetic cohort”—a cohort that has been created using available studies rather an ideal comparison with a randomized trial of deutetrabenazine vs valbenazine in a single cohort of patients with TD. Instead, this study provides an indirect comparison of 2 separate sets of studies with distinct cohorts and parameters—of either deutetrabenazine vs placebo or valbenazine vs placebo.
Simply stated, given bigger effect sizes for valbenazine vs placebo in the 2 sets of studies, the long-term projections, not surprisingly, look better for valbenazine.
It will be ideal to have a properly done randomized controlled trial comparing deutetrabenazine vs valbenazine in a single sample of patients all selected, dosed, and rated the same way by the same raters.