Eli Lilly and Company, Indianapolis, IN, USA.
J Med Econ. 2012;15(3):531-47. doi: 10.3111/13696998.2012.662923. Epub 2012 Feb 21.
Although the use of innovative drug delivery systems, like orally disintegrating antipsychotic tablets (ODT), may facilitate medication adherence and help reduce the risk of relapse and hospitalization, no information is available about the comparative cost-effectiveness of standard oral tablets (SOT) vs ODT formulations in the treatment of schizophrenia. This study compared the cost-effectiveness of olanzapine ODT and olanzapine SOT in the usual treatment of outpatients with schizophrenia from a US healthcare perspective. The study also compared olanzapine ODT with risperidone and aripiprazole, two other atypical antipsychotics available in both ODT and SOT formulations.
Published medical literature and a clinical expert panel were used to populate a 1-year Monte Carlo Micro-simulation model. The model captures clinical and cost parameters including adherence levels, treatment discontinuation by reason, relapse with and without inpatient hospitalization, quality-adjusted life years (QALYs), treatment-emergent adverse events, healthcare resource utilization, and associated costs. Key outcomes were total annual direct cost per treatment, QALY, and incremental cost-effectiveness (ICER) per 1 QALY gained.
Based on model projections, olanzapine ODT therapy was more costly ($9808 vs $9533), but more effective in terms of a lower hospitalization rate (15% vs 16%) and better QALYs (0.747 vs 0.733) than olanzapine SOT therapy. Olanzapine ODT was more cost-effective than olanzapine SOT (ICER: $19,643), more cost-effective than risperidone SOT therapy (ICER: $39,966), and dominant (meaning less costly and more effective) than risperidone ODT and aripiprazole in ODT or SOT formulations.
Lack of head-to-head randomized studies comparing the three studied atypical antipsychotics required making input assumptions that need further study.
This micro-simulation found that the utilization of olanzapine ODT for the treatment of schizophrenia is predicted to be more cost-effective than any other ODT or SOT formulations of the studied atypical antipsychotic medications.
虽然使用创新的药物输送系统，如口服崩解抗精神病药（ODT），可能有助于提高药物依从性，并有助于降低复发和住院风险，但目前尚无关于标准口服片剂（SOT）与 ODT 制剂在治疗精神分裂症方面的比较成本效益的信息。本研究从美国医疗保健的角度比较了奥氮平 ODT 和奥氮平 SOT 在治疗精神分裂症门诊患者中的成本效益。该研究还比较了奥氮平 ODT 与利培酮和阿立哌唑，这两种其他非典型抗精神病药也有 ODT 和 SOT 两种制剂。
使用已发表的医学文献和临床专家小组来填充为期 1 年的蒙特卡罗微观模拟模型。该模型捕获了包括依从性水平、因治疗中断、伴有和不伴有住院的复发、质量调整生命年（QALY）、治疗后出现的不良事件、医疗资源利用和相关成本在内的临床和成本参数。主要结果是每种治疗方法的年度直接总成本、QALY 和每获得 1 个 QALY 的增量成本效益（ICER）。
根据模型预测，奥氮平 ODT 治疗方案更昂贵（9808 美元对 9533 美元），但住院率较低（15%对 16%），QALY 更好（0.747 对 0.733），优于奥氮平 SOT 治疗方案。奥氮平 ODT 比奥氮平 SOT 更具成本效益（ICER：19643 美元），比利培酮 SOT 治疗方案更具成本效益（ICER：39966 美元），并且在 ODT 或 SOT 制剂中，比利培酮 ODT 和阿立哌唑更具成本效益（成本更低，效果更好）。
缺乏比较三种研究中的非典型抗精神病药物的头对头随机研究，这需要进一步研究输入假设。
本微观模拟研究发现，与研究中的其他任何 ODT 或 SOT 制剂相比，奥氮平 ODT 用于治疗精神分裂症的应用预计更具成本效益。
