AstraZeneca AB, Mölndal, Sweden.
Curr Med Res Opin. 2009 Mar;25(3):709-16. doi: 10.1185/03007990902738810.
The objective of this study was to assess the quality of life and drug costs associated with switching from any ongoing antipsychotic treatment to once-daily extended release quetiapine fumarate (quetiapine XR) in patients with schizophrenia.
This assessment was based on data collected during a 12-week study in patients with schizophrenia (n = 477) who switched from their current antipsychotic due to insufficient efficacy or poor tolerability to a flexible dose of quetiapine XR. Patients were assigned utilities based on their Positive and Negative Syndrome Scale (PANSS) scores and the presence of adverse events by applying the methods of Lenert et al.1. Quality adjusted life year (QALY) gains were calculated assuming a linear change of utility between two consecutive visits. Incremental costs were calculated by comparing the hypothetical mean drug cost (assuming patients stay on previous treatment) with the actual mean cost of quetiapine XR based on European prices.
Patients who completed the study (n = 279) increased their average utility by 0.116, corresponding to a QALY gain of 0.0207. For the total sample, the mean utility increased by 0.09, reflecting a QALY gain of 0.0170. The additional costs for quetiapine XR per QALY gained varied from approximately 16,000 euro to 24,000 euro. Notably, this is a non-comparative study; therefore, no conclusions can be reached regarding the relative impact of switching to quetiapine XR compared with other antipsychotics. Further limitations included the short trial duration on which the utility estimates are based, and the restriction of cost data to drug costs alone. Furthermore, in a 'real world' scenario, it is to be expected that other drug regimens might be introduced during periods of treatment failure.
This analysis demonstrates that patients with schizophrenia who switch their antipsychotic medication to quetiapine XR because of insufficient efficacy or poor tolerability benefit from significant QALY gains at a reasonable increase in drug cost.
本研究旨在评估精神分裂症患者由当前抗精神病药物切换至每日一次的富马酸喹硫平缓释片（quetiapine XR）治疗后的生活质量和药物费用。
本评估基于一项为期 12 周的研究数据，该研究纳入了 477 例因疗效不足或不耐受而切换至富马酸喹硫平 XR 灵活剂量的精神分裂症患者。根据阳性和阴性症状量表（PANSS）评分和不良反应的存在，应用 Lenert 等人的方法为患者分配效用值。假设效用值在两次连续就诊之间呈线性变化，计算出质量调整生命年（QALY）的获益。通过比较假设患者继续使用之前治疗方案的平均药物成本与基于欧洲价格的富马酸喹硫平 XR 的实际平均成本，计算出增量成本。
完成研究的患者（n=279）平均效用提高了 0.116，相当于 QALY 增加 0.0207。对于整个样本，平均效用提高了 0.09，反映出 QALY 增加 0.0170。每获得一个 QALY 增加的富马酸喹硫平 XR 额外成本约为 16000 至 24000 欧元。值得注意的是，这是一项非比较性研究；因此，无法就与其他抗精神病药物相比切换至富马酸喹硫平 XR 的相对影响得出结论。进一步的局限性包括基于效用估计的试验持续时间较短，以及成本数据仅限于药物成本。此外，在“现实世界”场景中，预计在治疗失败期间可能会引入其他药物治疗方案。
本分析表明，因疗效不足或不耐受而将抗精神病药物切换为富马酸喹硫平 XR 的精神分裂症患者，在药物成本略有增加的情况下，可获得显著的 QALY 获益。
