Bounthavong Mark, Okamoto Mark P
Western University of Health Sciences, College of Pharmacy, Pomona, CA 91766, USA.
J Eval Clin Pract. 2007 Jun;13(3):453-60. doi: 10.1111/j.1365-2753.2006.00782.x.
To evaluate the cost-effectiveness of three antipsychotic medications (olanzapine, risperidone and haloperidol) in the treatment of schizophrenia using the Positive and Negative Symptom Scale.
A decision analysis model was created to evaluate the cost-effectiveness of two atypical antipsychotics (risperidone and olanzapine) and haloperidol. Outcome probabilities were determined from published clinical trials. The main dependent variable of interest was to compare the incremental cost-effectiveness ratios (ICER) of the atypical antipsychotic with haloperidol, and also to compare the ICER of olanzapine and risperidone. Sensitivity analyses were conducted for olanzapine and risperidone to determine the effects of altering drug cost, efficacy and re-hospitalization rate on total costs.
Risperidone and olanzapine were dominant strategies compared with haloperidol (less costly and more effective). Risperidone was also dominant when compared with olanzapine. A one-way sensitivity analysis for efficacy indicated that the efficacy of risperidone would need to decrease by approximately 3% from the base-case in order for olanzapine and risperidone to have equal total costs. In a two-way sensitivity analysis varying both the cost of olanzapine and risperidone, the difference in drug costs between them would have to increase from $2.12 per day to $4.12 per day in order to have equal total costs. In terms of varying re-hospitalization rates, the re-hospitalization rate for risperidone would have to increase from 3% to 33% greater than the re-hospitalization rate for olanzapine in order to have equal total direct costs.
Based on this decision model, atypical antipsychotics were a dominant strategy over haloperidol primarily because of increased efficacy and lower re-hospitalizations. The ICER indicated that risperidone was dominant over olanzapine because of lower drug costs and increased number of responders, which leads to decreased total costs.
使用阳性和阴性症状量表评估三种抗精神病药物（奥氮平、利培酮和氟哌啶醇）治疗精神分裂症的成本效益。
创建一个决策分析模型来评估两种非典型抗精神病药物（利培酮和奥氮平）以及氟哌啶醇的成本效益。结果概率由已发表的临床试验确定。主要关注的因变量是比较非典型抗精神病药物与氟哌啶醇的增量成本效益比（ICER），同时比较奥氮平和利培酮的ICER。对奥氮平和利培酮进行敏感性分析，以确定改变药物成本、疗效和再住院率对总成本的影响。
与氟哌啶醇相比，利培酮和奥氮平是占优策略（成本更低且更有效）。与奥氮平相比，利培酮也是占优策略。疗效的单向敏感性分析表明，为使奥氮平和利培酮的总成本相等，利培酮的疗效需要从基线情况下降约3%。在同时改变奥氮平和利培酮成本的双向敏感性分析中，它们之间的药物成本差异必须从每天2.12美元增加到每天4.12美元，总成本才会相等。就改变再住院率而言，利培酮的再住院率必须比奥氮平的再住院率高出3%至33%，直接总成本才会相等。
基于此决策模型，非典型抗精神病药物是优于氟哌啶醇的占优策略，主要是因为疗效提高和再住院率降低。ICER表明，利培酮优于奥氮平，因为药物成本更低且应答者数量增加，从而导致总成本降低。
