Sunovion Pharmaceuticals Inc., Marlborough, MA, USA.
J Med Econ. 2013 Jul;16(7):951-61. doi: 10.3111/13696998.2013.807813. Epub 2013 Jun 7.
Compare long-term costs and outcomes of lurasidone to aripiprazole among adults with schizophrenia in the US who previously failed ≥1 atypical antipsychotic (olanzapine, risperidone, quetiapine, or ziprasidone) based on an indirect comparison of outcomes data from clinical trials.
A 5-year Markov cohort model was developed to compare long-term effectiveness of lurasidone to aripiprazole, including total discontinuations, relapse rates, and hospitalization rates. Cost inputs included pharmacy, mental health, and medical costs associated with cardiometabolic risks (diabetes and cardiovascular [CV] events). Effectiveness inputs were derived from an indirect comparison of aripiprazole and lurasidone using common comparators from CATIE. Cardiometabolic risks were derived from claims data analysis for diabetes, weight change and CV events, and Framingham body mass index (BMI) risk equation. Cost inputs were derived from published sources and Red Book. Costs and outcomes were discounted at 3% and tested with sensitivity analyses.
Over 5 years, total discounted costs for lurasidone and aripiprazole patients were $86,480 and $90,500, respectively. During this period, the number of relapses per patient, hospitalizations per patient, diabetes rates, and CV events per 1000 patients, respectively, were estimated to be lower for lurasidone (0.442, 0.245, 7.29%, and 37.3) than aripiprazole (0.478, 0.369, 7.36%, and 37.8). Results were sensitive to lurasidone and aripiprazole hospitalization rates. At a willingness-to-pay threshold of $50,000 per hospitalization avoided, lurasidone had a 100% probability of being more cost-effective than aripiprazole.
The model was based on results from various comparative clinical trials. Differences in patient population and study methods may change estimates from the model. The model does not account for patient heterogeneity.
Based on this model, when switching from another atypical antipsychotic, lurasidone had fewer relapses and hospitalizations with a lower incidence of diabetes and CV events than aripiprazole. Additionally, lurasidone may be less costly than aripiprazole among adults with schizophrenia.
通过对来自临床试验的结果数据进行间接比较，在既往使用过至少 1 种非典型抗精神病药物（奥氮平、利培酮、喹硫平或齐拉西酮）治疗失败的美国精神分裂症成年患者中，比较氨磺必利与阿立哌唑的长期成本和结局。
开发了一个 5 年的 Markov 队列模型，以比较氨磺必利与阿立哌唑的长期疗效，包括总停药率、复发率和住院率。成本投入包括与代谢心血管风险（糖尿病和心血管[CV]事件）相关的药房、精神健康和医疗成本。有效性投入来自 CATIE 中使用的共同对照药物对阿立哌唑和氨磺必利的间接比较。代谢心血管风险来自糖尿病、体重变化和 CV 事件以及 Framingham 体重指数（BMI）风险方程的索赔数据分析。成本投入来自已发表的资料和 Red Book。成本和结果以 3%贴现，并进行敏感性分析。
在 5 年内，氨磺必利和阿立哌唑患者的总贴现成本分别为 86480 美元和 90500 美元。在此期间，预计氨磺必利患者的每位患者复发次数、每位患者住院次数、糖尿病发生率和每 1000 名患者的 CV 事件发生率分别为 0.442、0.245、7.29%和 37.3，低于阿立哌唑（0.478、0.369、7.36%和 37.8）。结果对氨磺必利和阿立哌唑的住院率敏感。在避免每次住院费用 50000 美元的意愿支付阈值下，氨磺必利 100%的可能性比阿立哌唑更具成本效益。
该模型基于来自各种对照临床试验的结果。患者人群和研究方法的差异可能会改变模型的估计值。该模型没有考虑到患者的异质性。
基于该模型，与另一种非典型抗精神病药物相比，换用氨磺必利时，精神分裂症成年患者的复发和住院次数更少，糖尿病和 CV 事件的发生率更低。此外，氨磺必利的成本可能低于阿立哌唑。
