Tunis Sandra L, Faries Douglas E, Nyhuis Allen W, Kinon Bruce J, Ascher-Svanum Haya, Aquila Ralph
US Medical Division, Eli Lilly and Company, Indianapolis, IN 46285, USA.
Value Health. 2006 Mar-Apr;9(2):77-89. doi: 10.1111/j.1524-4733.2006.00083.x.
This randomized, open-label trial was designed to help inform antipsychotic treatment policies. It compared the 1-year cost-effectiveness of initial treatment with olanzapine (OLZ) (n = 229) versus a "fail-first" algorithm on conventional antipsychotics (then olanzapine if indicated) (CON) (n = 214); and versus initial treatment with risperidone (RIS) (n = 221).
Individuals with schizophrenia or schizoaffective disorder were recruited from May 1998 to September 2001. Clinical, functioning, and resource utilization data were collected at baseline and five postbaseline visits. Brief Psychiatric Rating Scale scores defined "clinical effectiveness;" Lehman Quality of Life Scale social relations scores defined "social effectiveness."
Requiring failure on less expensive antipsychotics before use of olanzapine did not result in total cost savings, despite significantly higher antipsychotic costs with OLZ. Total 1-year mean costs were 21,283 dollars for CON; 20,891 dollars for OLZ; and 21,347 dollars for RIS (pair-wise comparisons nonsignificant). Intent-to-treat effectiveness comparisons (nonsignificant) were augmented by analyses that adjusted for duration on initial antipsychotic treatment, and by comparisons of patients remaining on initial antipsychotic treatment versus those who required switching. When accounting for differential switching rates (OLZ 0.14 vs. CON 0.53, P < 0.0001; vs. RIS 0.31, P < 0.0001), OLZ was significantly more effective than CON on clinical (P = 0.025) and social (P = 0.043) measures, and significantly more effective than RIS on the social (P = 0.002) measure. Further, patients initiated on an antipsychotic from which they needed to switch required additional resources for hospitalization (P = 0.036) and crisis services (P = 0.029).
Approaches that integrate costs, effectiveness, and treatment patterns are important for providing optimal information regarding the value of first-line antipsychotic options for schizophrenia.
本随机、开放标签试验旨在为抗精神病药物治疗政策提供信息。比较了奥氮平（OLZ）初始治疗（n = 229）与传统抗精神病药物“先失败”算法（如需要则使用奥氮平）（CON）（n = 214）的1年成本效益；以及与利培酮（RIS）初始治疗（n = 221）的成本效益。
1998年5月至2001年9月招募了患有精神分裂症或分裂情感性障碍的个体。在基线和基线后五次随访时收集临床、功能和资源利用数据。简明精神病评定量表评分定义“临床疗效”；莱曼生活质量量表社会关系评分定义“社会疗效”。
在使用奥氮平之前先使用价格较低的抗精神病药物失败，并未节省总成本，尽管奥氮平的抗精神病药物成本显著更高。CON组1年总平均成本为21,283美元；OLZ组为20,891美元；RIS组为21,347美元（两两比较无显著差异）。意向性治疗疗效比较（无显著差异）通过对初始抗精神病药物治疗持续时间进行调整的分析以及对继续使用初始抗精神病药物治疗的患者与需要换药的患者进行比较得到加强。考虑到换药率差异（OLZ为0.14，CON为0.53，P < 0.0001；与RIS为0.31，P < 0.0001），OLZ在临床（P = 0.025）和社会（P = 0.043）指标上比CON显著更有效，在社会（P = 0.002）指标上比RIS显著更有效。此外，开始使用抗精神病药物后需要换药的患者需要额外的住院资源（P = 0.036）和危机服务资源（P = 0.029）。
整合成本、疗效和治疗模式的方法对于提供有关精神分裂症一线抗精神病药物选择价值的最佳信息非常重要。
