Oxford Outcomes, Oxford, UK.
Curr Med Res Opin. 2008 Nov;24(11):3275-85. doi: 10.1185/03007990802507547. Epub 2008 Oct 22.
To evaluate the cost-effectiveness of atypical antipsychotic treatment sequences for the management of stable schizophrenia in the UK.
A Markov model was developed to assess the cost per quality-adjusted life year (QALY) gained from 12 alternative treatment sequences each containing two of four atypical antipsychotics (aripiprazole, olanzapine, quetiapine and risperidone), followed by clozapine. The main model parameters were populated with data from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study and a recent trial comparing aripiprazole with olanzapine. Patients enter the model with stable schizophrenia and may relapse, discontinue or continue and experience adverse events (AEs), or develop diabetes. Population mortality was adjusted for schizophrenia and diabetes. Utility decrements applied to stable schizophrenia, relapse, diabetes and treatment-related AEs were taken from a direct UK utility elicitation study. Resource use and unit costs were taken from published sources. A time horizon of 10 years was adopted. Results are based on 10,000 probabilistic iterations of the model.
Aripiprazole followed by risperidone produced the greatest number of QALYs, an additional 0.03 compared with risperidone followed by olanzapine, at an incremental cost of £257 (incremental cost/QALY: £9,440). Aripiprazole followed by risperidone had the greatest probability among evaluated sequences of being cost-effective at a threshold of >£10,000/QALY. All other strategies were dominated by at least one of these strategies. The impact of lower pricing for risperidone (based on generic availability) did not impact results.
Modelling the cost-effectiveness of different treatment sequences for stable schizophrenia is appropriate given that patients rarely remain on one treatment for long periods. The treatment sequence aripiprazole followed by risperidone was the most cost-effective option for patients with stable schizophrenia in the UK.
评估英国稳定期精神分裂症管理中，非典型抗精神病药物治疗序贯的成本效益。
建立了一个 Markov 模型，评估 12 种替代治疗序贯方案的成本效益，每个方案包含四种非典型抗精神病药物（阿立哌唑、奥氮平、喹硫平和利培酮）中的两种，随后是氯氮平。主要模型参数来自于临床抗精神病药物干预效果试验（CATIE）研究和最近一项比较阿立哌唑与奥氮平的试验。患者进入模型时患有稳定的精神分裂症，可能会复发、停药或继续治疗并出现不良反应（AE），或患上糖尿病。调整了精神分裂症和糖尿病患者的人口死亡率。稳定精神分裂症、复发、糖尿病和与治疗相关的 AE 应用了直接来自英国效用研究的效用降低。资源利用和单位成本来自已发表的来源。采用了 10 年的时间范围。结果基于模型的 10000 次概率迭代。
阿立哌唑序贯利培酮产生的 QALY 数量最多，比利培酮序贯奥氮平多 0.03，增量成本为 257 英镑（增量成本/QALY：9440 英镑）。在评估的序列中，阿立哌唑序贯利培酮在成本效益阈值大于 10000 英镑/QALY 时最有可能成为成本效益。所有其他策略都至少被一种策略所主导。利培酮价格降低（基于仿制药可用性）的影响并不影响结果。
鉴于患者很少长期使用一种治疗方法，对不同治疗序贯治疗稳定期精神分裂症的成本效益进行建模是合适的。对于英国的稳定期精神分裂症患者，阿立哌唑序贯利培酮是最具成本效益的选择。
