School of Public Health, Peking University Health Science Center, Beijing, China.
Value Health. 2009 Nov-Dec;12 Suppl 3:S66-9. doi: 10.1111/j.1524-4733.2009.00630.x.
To determine the most cost-effective strategy involving first-line treatment with long-acting risperidone, olanzapine, and quetiapine from the perspective of the Chinese health-care system.
A decision analytical model was applied. The model used a time horizon of 2 years. The probabilities of treatment response of different agents and the relapse and hospitalization rates were estimated by a Delphi panel of 17 senior psychiatrists in China. The unit cost for each medical service was calculated from the price system database built by China National Development and Reform Commission and the medical resource utilization was estimated by the Delphi panel. The principal efficacy measure was the proportion of patients successfully treated. Various sensitivity analyses were carried out to test the robustness of the model.
The proportion of patients successfully treated over the 2-year period was 46.71% for long-acting risperidone, 39.93% for olanzapine, and 31.28% for quetiapine. The mean cost-effectiveness ratios were RMB189,427, RMB202,432, and RMB233,015 per successfully treated patient for long-acting risperidone, quetiapine and olanzapine, respectively. Results of the sensitivity analyses confirmed that the results were robust.
The results showed that long-acting risperidone is more cost-effective than olanzapine and quetiapine for patients with schizophrenia in long-term maintenance treatment.
从中国医疗体系的角度出发，确定长效利培酮、奥氮平、喹硫平作为一线治疗药物的最具成本效益的治疗策略。
采用决策分析模型。该模型的时间范围为 2 年。不同药物的治疗反应概率以及复发和住院率，由中国 17 位资深精神科医生组成的德尔菲小组进行评估。各医疗服务的单位成本根据国家发展和改革委员会建立的价格体系数据库计算，医疗资源的利用情况由德尔菲小组进行评估。主要疗效指标为成功治疗的患者比例。对模型进行了各种敏感性分析以检验其稳健性。
长效利培酮、奥氮平、喹硫平治疗 2 年的成功治疗患者比例分别为 46.71%、39.93%、31.28%。长效利培酮、喹硫平、奥氮平每成功治疗 1 例患者的平均成本效益比分别为人民币 189427 元、人民币 202432 元、人民币 233015 元。敏感性分析的结果证实了结果的稳健性。
结果表明，长效利培酮在长期维持治疗中对精神分裂症患者比奥氮平和喹硫平更具成本效益。
