Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, Ontario, Canada.
J Eval Clin Pract. 2010 Aug;16(4):744-55. doi: 10.1111/j.1365-2753.2009.01189.x. Epub 2010 Jun 10.
RATIONALE, AIMS AND OBJECTIVES: Second-generation antipsychotic agents have varying propensities to cause weight gain, elevated lipid levels and associated long-term complications. This study evaluates the cost-effectiveness of four second-generation antipsychotic agents used in Canada for the treatment of schizophrenia (ziprasidone, olanzapine, quetiapine, risperidone) with a focus on their long-term metabolic consequences.
Using data from the Clinical Antipsychotic Trials of Intervention Effectiveness Study, a semi-Markov model was developed to predict the incidence and associated costs of type 2 diabetes, cardiovascular complications (e.g. angina, myocardial infarction, stroke, cardiovascular disease death), and acute psychiatric hospitalizations in patients with chronic schizophrenia treated over 5 years. Incremental costs per quality-adjusted life year (QALY) gained were calculated from the perspective of the Canadian provincial ministries of health. Scenario and probabilistic sensitivity analyses were performed.
The total average cost of treatment with ziprasidone was $25,301 versus $28,563 with olanzapine, $26,233 with quetiapine and $21,831 with risperidone. Ziprasidone had the lowest predicted number of type 2 diabetes cases and cardiovascular disease events, and the highest QALY gains. Patients receiving quetiapine had the highest predicted number of hospitalizations. Ziprasidone was less costly and resulted in more QALYs compared with olanzapine and quetiapine. Compared with risperidone, ziprasidone was more costly and had higher QALYs, with an incremental cost per QALY gained of $218,060.
Compared with olanzapine and quetiapine, ziprasidone produced savings to the health care system. Although ziprasidone generated incremental expenditures versus risperidone, it resulted in more QALYs. Based on this analysis, ziprasidone treatment possesses cost and therapeutic advantages compared with olanzapine and quetiapine.
背景、目的和目标：第二代抗精神病药物引起体重增加、血脂升高和相关长期并发症的倾向不同。本研究评估了在加拿大用于治疗精神分裂症的四种第二代抗精神病药物（齐拉西酮、奥氮平、喹硫平、利培酮）的成本效益，重点是它们的长期代谢后果。
使用来自干预效果临床试验的临床抗精神病药物数据，开发了一个半马尔可夫模型，以预测慢性精神分裂症患者在 5 年内接受治疗时发生 2 型糖尿病、心血管并发症（如心绞痛、心肌梗死、中风、心血管疾病死亡）和急性精神病院住院的概率和相关成本。从加拿大省级卫生部门的角度计算了每获得一个质量调整生命年（QALY）的增量成本。进行了情景和概率敏感性分析。
与奥氮平相比，齐拉西酮的总平均治疗费用为 25301 加元，奥氮平为 28563 加元，喹硫平为 26233 加元，利培酮为 21831 加元。齐拉西酮预测的 2 型糖尿病病例和心血管疾病事件数量最少，QALY 增益最高。接受喹硫平治疗的患者住院人数最多。与奥氮平和喹硫平相比，齐拉西酮的费用更低，QALY 更高。与利培酮相比，齐拉西酮的费用更高，QALY 更高，增量成本每 QALY 获得 218060 加元。
与奥氮平和喹硫平相比，齐拉西酮为医疗保健系统节省了成本。尽管齐拉西酮与利培酮相比产生了增量支出，但它产生了更多的 QALY。基于这项分析，与奥氮平和喹硫平相比，齐拉西酮治疗在成本和疗效方面具有优势。
