Pharmerit BV, Rotterdam, The Netherlands.
J Med Econ. 2012;15 Suppl 1:26-34. doi: 10.3111/13696998.2012.734884. Epub 2012 Oct 23.
Paliperidone Extended Release OROS (ER) is a new atypical antipsychotic for the treatment of schizophrenia. The objective is, based on a previously published model, to analyze the clinical and economic effects of Paliperidone ER in a Spanish setting compared to olanzapine oral and aripiprazole.
An existing discrete event simulation model was adapted to reflect the treatment of schizophrenia in Spain in terms of costs, resource use, and treatment patterns. Inputs for the model were derived from clinical trial data, literature research, database analysis and interviews with local clinical experts. The time horizon is 5 years and Spanish discount rate was applied. Outputs include direct medical costs and Quality Adjusted Life-Years (QALYs). Extensive sensitivity analyses were carried out to assess the robustness of the results, using ordinary least squares analysis and cost-effectiveness scatter plots.
The results show that the mean incremental QALYs (95% CI) compared to olanzpine is 0.033 [-0.143, 0.304] and compared to aripiprazole 0.029 [-0.107, 0.300]. The corresponding mean incremental costs and corresponding confidence intervals are -€1425 [-€10,247, €3084] and -€759 [-€10,479, €3404], respectively. The probability that paliperidone ER is cost-saving and health gaining compared to olanzapine and aripiprazole is 76% and 72%, respectively. Paliperidone ER was estimated to have 80% and 81% probability of being cost-effective compared to olanzapine at a willingness to pay of €20,000 and €30,000 and 73% and 74% compared to aripiprazole, respectively.
Some of the modeled inter-relationships had to be based on expert opinion due to a lack of information. Also, foreign sources for the disutility of adverse events had been used due to a lack of Spanish data. Prolactin-related side-effects, indirect costs, and potential compliance advantages of paliperidone ER were not considered. It is unlikely that these limitations affected the conclusions.
Based on differences in drug acquisition costs, side-effects, and risk of relapse, the model predicts that, in the Spanish healthcare setting, paliperidone ER dominates oral olanzapine and aripiprazole, with a probability of 76% and 72%, respectively.
帕利哌酮延释片（ER）是一种新型的抗精神分裂症的非典型抗精神病药物。本研究旨在根据先前发表的模型，分析帕利哌酮 ER 在西班牙的临床和经济效果，与奥氮平口服制剂和阿立哌唑进行比较。
我们对现有的离散事件模拟模型进行了调整，以反映在西班牙治疗精神分裂症方面的成本、资源利用和治疗模式。模型的输入数据来自临床试验数据、文献研究、数据库分析和与当地临床专家的访谈。时间范围为 5 年，采用西班牙贴现率。产出包括直接医疗成本和质量调整生命年（QALYs）。使用普通最小二乘分析和成本效果散点图进行了广泛的敏感性分析，以评估结果的稳健性。
与奥氮平相比，帕利哌酮 ER 的平均增量 QALYs（95%CI）为 0.033（-0.143，0.304），与阿立哌唑相比为 0.029（-0.107，0.300）。相应的增量成本及置信区间分别为-€1425（-€10，247，€3084）和-€759（-€10，479，€3404）。与奥氮平相比，帕利哌酮 ER 的增量成本和增量 QALYs 分别有 76%和 72%的概率具有成本效益。与奥氮平相比，帕利哌酮 ER 具有 80%和 81%的概率在 20000 欧元和 30000 欧元的意愿支付水平下具有成本效益，与阿立哌唑相比，分别具有 73%和 74%的概率具有成本效益。
由于缺乏信息，某些模型中的相互关系必须基于专家意见。此外，由于缺乏西班牙数据，因此使用了国外来源的不良反应失能数据。未考虑催乳素相关副作用、间接成本和帕利哌酮 ER 的潜在依从性优势。不太可能这些局限性会影响结论。
基于药物获得成本、副作用和复发风险的差异，该模型预测，在西班牙医疗保健环境中，帕利哌酮 ER 优于奥氮平口服制剂和阿立哌唑，概率分别为 76%和 72%。
