Beard Stephen M, Maciver Fiona, Clouth Johannes, Rüther Eckart
RTI Health Solutions, Manchester, UK.
Eur J Health Econ. 2006 Sep;7(3):165-72. doi: 10.1007/s10198-006-0347-0.
Second-generation atypical antipsychotics such as clozapine, olanzapine, risperidone, quetiapine, ziprasidone, amisulpride and ariprazole offer the potential to reduce the significant health care resource demands in the treatment of schizophrenia through improved levels of initial clinical response and reduced levels of long-term acute relapse. However, the optimal sequencing of these drugs remains unclear. To consider this issue from a health economic viewpoint a decision model approach was used comparing healthcare costs and clinical outcomes when treating patients with alternative sequences of atypical antipsychotic treatment. Treated patients were assumed to be in a current acute episode with at least a 10-year history of disease and to be naive to previous atypical treatments. Treatment strategies were based on either first-line olanzapine or risperidone with switching to the alternative drug as second-line treatment following an inadequate clinical response to first-line drug therapy. Clinical response data were derived from a pivotal published comparative study of both olanzapine and risperidone. Published data on the long-term use of antipsychotic drugs where used wherever possible to populate the model for relapse rates during the maintenance phase. Health care resource data were defined for Germany based on expert clinical opinion. A treatment strategy of first-line olanzapine was shown to be cost saving over a 1-year period, with additional clinical benefits in the form of avoided relapses. The model suggests that over the first year of treatment a strategy of first-line olanzapine is associated with lower risk of additional relapse (0.33 fewer acute relapses per 100 patients per year) and with cost savings (euro 35,306 per 100 patients per year). There is a need for longer term direct in-trial comparisons of atypical antipsychotics to confirm these indicative results.
第二代非典型抗精神病药物，如氯氮平、奥氮平、利培酮、喹硫平、齐拉西酮、氨磺必利和阿立哌唑，有可能通过提高初始临床反应水平和降低长期急性复发率，减少精神分裂症治疗中对大量医疗资源的需求。然而，这些药物的最佳用药顺序仍不明确。为了从卫生经济学角度考虑这个问题，我们采用了决策模型方法，比较了使用非典型抗精神病药物的不同治疗顺序治疗患者时的医疗成本和临床结果。假设接受治疗的患者处于当前急性发作期，至少有10年的疾病史，且之前未接受过非典型治疗。治疗策略基于一线使用奥氮平或利培酮，在对一线药物治疗临床反应不足后，二线改用另一种药物。临床反应数据来自一项已发表的奥氮平和利培酮的关键对比研究。尽可能使用已发表的抗精神病药物长期使用数据来填充模型，以反映维持期的复发率。基于专家临床意见确定了德国的医疗资源数据。结果显示，一线使用奥氮平的治疗策略在1年内具有成本节约效益，并且有避免复发等额外的临床益处。该模型表明，在治疗的第一年，一线使用奥氮平的策略与额外复发风险较低（每100名患者每年急性复发减少0.33次）以及成本节约（每100名患者每年节约35,306欧元）相关。需要对非典型抗精神病药物进行更长期的直接试验比较，以证实这些初步结果。
