Health Services Consulting Corporation, Boxborough, MA 01719, USA.
J Med Econ. 2012;15(4):623-34. doi: 10.3111/13696998.2012.667465. Epub 2012 Feb 29.
To identify, estimate, and compare 'real world' costs and outcomes associated with paliperidone palmitate compared with branded oral atypical anti-psychotics, and to estimate the threshold rate of oral atypical adherence at which paliperidone palmitate is cost saving.
Decision analytic modeling techniques developed by Glazer and Ereshefsky have previously been used to estimate the cost-effectiveness of depot haloperidol, LAI risperidone, and, more recently, LAI olanzapine. This study used those same techniques, along with updated comparative published clinical data, to evaluate paliperidone palmitate. Adherence rates were based on strict Medication Event Monitoring System (MEMS) criteria. The evaluation was conducted from the perspective of US healthcare payers.
Paliperidone palmitate patients had fewer mean annual days of relapse (8.7 days; 6.0 requiring hospitalization, 2.7 not requiring hospitalization vs 17.8 days; 12.4 requiring hospitalization, 5.4 not requiring hospitalization), and lower annual total cost ($20,995) compared to oral atypicals (mean $22,481). Because paliperidone palmitate was both more effective and less costly, it is considered economically dominant. Paliperidone palmitate saved costs when the rate of adherence of oral atypical anti-psychotics was below 44.9% using strict MEMS criteria. Sensitivity analyses showed results were robust to changes in parameter values. For patients receiving 156 mg paliperidone palmitate, the annual incremental cost was $1216 per patient (ICER = $191 per day of relapse averted). Inclusion of generic risperidone (market share 18.6%) also resulted in net incremental cost for paliperidone palmitate ($120; ICER = $13). Limitations of this evaluation include use of simplifying assumptions, data from multiple sources, and generalizability of results.
Although uptake of LAIs in the US has not been as rapid as elsewhere, many thought leaders emphasize their importance in optimizing outcomes in patients with adherence problems. The findings of this analysis support the cost-effectiveness of paliperidone palmitate in these patients.
确定、评估和比较棕榈酸帕利哌酮与品牌口服非典型抗精神病药物相关的“真实世界”成本和结果，并估计口服非典型药物依从率达到多少时，棕榈酸帕利哌酮具有成本效益。
Glazer 和 Ereshefsky 开发的决策分析模型技术此前已用于评估长效氟哌啶醇、利培酮 LA I 和最近的奥氮平 LA I 的成本效益。本研究使用了相同的技术，并结合最新的已发表的临床比较数据，来评估棕榈酸帕利哌酮。依从率基于严格的用药事件监测系统（MEMS）标准。该评估从美国医疗保健支付者的角度进行。
与口服非典型药物相比，棕榈酸帕利哌酮患者的年平均复发天数更少（8.7 天，6.0 天需要住院治疗，2.7 天不需要住院治疗，而 17.8 天，12.4 天需要住院治疗，5.4 天不需要住院治疗），年度总费用也更低（20995 美元）。由于棕榈酸帕利哌酮更有效且成本更低，因此被认为具有经济优势。当口服非典型抗精神病药物的依从率低于严格 MEMS 标准的 44.9%时，棕榈酸帕利哌酮可节省成本。敏感性分析表明，结果对参数值的变化具有稳健性。对于接受 156mg 棕榈酸帕利哌酮的患者，每位患者的年度增量成本为 1216 美元（增量成本效益比为每避免 1 天复发 191 美元）。包含利培酮仿制药（市场份额 18.6%）也导致棕榈酸帕利哌酮的净增量成本为 120 美元（增量成本效益比为 13 美元）。本评估的局限性包括使用简化假设、来自多个来源的数据以及结果的通用性。
尽管 LAIs 在美普及速度不如其他地区快，但许多思想领袖强调它们在优化有服药依从性问题的患者的治疗结果方面的重要性。本分析结果支持棕榈酸帕利哌酮在这些患者中的成本效益。
