i3 Innovus, Stockholm, Sweden.
Acta Psychiatr Scand. 2011 Sep;124(3):214-25. doi: 10.1111/j.1600-0447.2011.01716.x. Epub 2011 May 24.
To assess the cost-effectiveness of aripiprazole versus olanzapine in the treatment of patients with schizophrenia or bipolar disorder in Sweden with focus on the metabolic impact of the treatments.
A Markov health-state transition model was developed. The risks of developing metabolic syndrome after one year of treatment with aripiprazole or olanzapine were derived from a pooled analysis of three randomised clinical trials. The subsequent risks of developing diabetes or coronary heart disease were based on previously published risk models. A societal perspective was applied, adopting a lifetime horizon. Univariate and probabilistic sensitivity analyses were conducted.
Treatment with aripiprazole dominates over olanzapine in both schizophrenia and bipolar disorder. In schizophrenia, quality-adjusted life-years (QALYs) gained were 0.08 and cost savings Swedish kronor (SEK) 30,570 (USD 4000); in bipolar disorder, QALYs gained were 0.09 and cost savings SEK 28,450 (USD 3720). In probabilistic sensitivity analyses, aripiprazole resulted in a dominant outcome in 84% of cases in schizophrenia and in 77% of cases in bipolar syndrome.
The significantly lower risk of developing metabolic syndrome observed with aripiprazole compared with olanzapine is associated with less risk of diabetes and cardiovascular morbidity and mortality that translates into lower overall treatment cost and improved quality of life over time.
评估阿立哌唑与奥氮平治疗瑞典精神分裂症或双相情感障碍患者的成本效益，重点关注治疗的代谢影响。
开发了一个马尔可夫健康状态转移模型。从三项随机临床试验的汇总分析中得出了使用阿立哌唑或奥氮平治疗一年后发生代谢综合征的风险。随后发生糖尿病或冠心病的风险基于先前发表的风险模型。采用社会视角，采用终生时间范围。进行了单变量和概率敏感性分析。
在精神分裂症和双相情感障碍中，阿立哌唑治疗均优于奥氮平。在精神分裂症中，获得的质量调整生命年（QALY）为 0.08，节省瑞典克朗（SEK）30570 美元（4000 美元）；在双相情感障碍中，获得的 QALY 为 0.09，节省 SEK 28450 美元（3720 美元）。在概率敏感性分析中，阿立哌唑在精神分裂症 84%的情况下和双相情感障碍 77%的情况下导致主导结果。
与奥氮平相比，阿立哌唑观察到的代谢综合征发生风险显著降低，与糖尿病和心血管发病率和死亡率的风险降低相关，这转化为总体治疗成本降低和随着时间的推移生活质量提高。
