Since the 1950s, when the movement disorder tardive dyskinesia (TD) was first described, several drugs have been studied for potential effectiveness or used off-label for the treatment of TD, but none provided clear evidence of clinical benefit.  In 2017, however, the US Food and Drug Administration (FDA) approved valbenazine, a novel and highly selective vesicular monoamine transporter 2 (VMAT2) inhibitor, for the treatment of TD in adults; the FDA approval of a second VMAT2 inhibitor, deutetrabenazine, followed later that year.

More recently, the American Psychiatric Association (APA) released its evidence-based practice guideline for treatment of patients with schizophrenia, that includes the recommendation (based on results from randomized clinical trials) that patients with moderate-to-severe TD be treated with a VMAT2.

For a paper published in the Journal of Medical Economics, the researchers aimed to evaluate clinical and economic outcomes associated with valbenazine compared with deutetrabenazine in patients with TD, using a model that accounts for multiple dimensions for patient health status. A discretely integrated condition event was developed to evaluate the cost-effectiveness of treatment with valbenazine and deutetrabenazine in a synthetic cohort of 1,000 patients with TD who were receiving antipsychotic medication treat an underlying psychiatric disorder.

Patients Had Better Response to Valbenazine

Clinical inputs were derived from relevant clinical trials or from publicly available sources. Patients were assessed throughout 1 year using ≥50% improvement from baseline in Abnormal Involuntary Movement Scale (AIMS) total score as the primary definition of response. Response at 1 year using Clinical Global Impression of Change (CGIC) score at ≤2 was also accessed. Health outcomes included quality-adjusted life years (QALYs), life years, proportion responding to treatment at 1 year, and number of psychiatric relapses.

“Regardless of the definition used for response, 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,” the study authors write.  Using AIMS response criterion, the increment cost-effective ration 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.

albenazine Linked With Longer Life Expectancy

“In patients with TD, treatment with valbenazine was associated with longer life expectancy and better quality of life (QOL), measured by QALYs, compared with deutetrabenazine,” the study team writes. “Over a lifetime, valbenazine was more effective than deutetrabenazine, and either less costly or associated with increased costs well below established cost per QALY thresholds, depending on the response criterion evaluated.”

The study authors concur that the effect of reduced TD symptoms on the use of antipsychotic agents and psychiatric relapse should be further explored and that new, validated measures that accurately reflect patient and caregiver perspectives on disease burden and QOL are needed. “The results of this study may assist payers in making more fully informed decisions regarding treatment of TD,” they write.

Cost-Effectiveness of Valbenazine Compared With Deutetrabenazine for the Treatment of Tardive Dyskinesia