Zeidler Jan, Mahlich Jörg, Greiner Wolfgang, Heres Stephan
Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Königsworther Platz 1, D-30167, Hannover, Germany,
Appl Health Econ Health Policy. 2013 Oct;11(5):509-21. doi: 10.1007/s40258-013-0050-0.
Treatment with antipsychotic medication is an important element of relapse prevention in the management of schizophrenia, and can reduce inpatient stays. Recently, the long-acting atypical antipsychotic paliperidone long-acting injectable (PLAI), a once-monthly LAI antipsychotic, was approved for treatment of schizophrenia in Germany.
To estimate, based on a previously published model, the cost effectiveness of PLAI compared with other common antipsychotic treatment strategies in patients diagnosed with schizophrenia in Germany.
A Markov decision analytic model was adapted to the German healthcare system. The model considers the cost effectiveness for PLAI as a maintenance treatment for patients with schizophrenia from the payer perspective. The patients transition between eight health states on a monthly basis over a 5-year time horizon. As therapeutic strategies, PLAI, quetiapine, risperidone long-acting injections (RLAI), oral olanzapine, oral risperidone, zuclopenthixol decanoate, olanzapine long-acting injections (OLAI), oral typical and oral atypical were compared. Probability of relapse, level of adherence, side effects and treatment discontinuation were derived from the Swedish original model. Input factors regarding resource use and costs were estimated and adjusted for the German healthcare system. A probabilistic sensitivity analyses (PSA) using cost-effectiveness scatter plots was performed to visualize the robustness of the results.
In base-case scenario, PLAI is superior to RLAI in gained quality-adjusted life-years (QALYs) and avoided relapses. Relative to all other treatment strategies, PLAI is more effective with regard to gained QALYs and avoided relapses but results in higher treatment costs over a 5-year horizon in base-case scenario. The results were tested in PSA. If a cost-effectiveness threshold of
PLAI dominates RLAI and compared with the other treatment strategies PLAI has shown to be more effective but results in higher costs in base-case scenario.
抗精神病药物治疗是精神分裂症管理中预防复发的重要组成部分，并且可以减少住院时间。最近，长效非典型抗精神病药物帕利哌酮长效注射剂（PLAI），一种每月注射一次的长效抗精神病药物，在德国被批准用于治疗精神分裂症。
基于先前发表的模型，评估在德国被诊断为精神分裂症的患者中，PLAI与其他常见抗精神病治疗策略相比的成本效益。
将一个马尔可夫决策分析模型应用于德国医疗保健系统。该模型从支付方的角度考虑PLAI作为精神分裂症患者维持治疗的成本效益。患者在5年的时间范围内每月在8种健康状态之间转换。作为治疗策略，对PLAI、喹硫平、利培酮长效注射剂（RLAI）、口服奥氮平、口服利培酮、癸酸珠氯噻醇、奥氮平长效注射剂（OLAI）、口服典型抗精神病药物和口服非典型抗精神病药物进行了比较。复发概率、依从性水平、副作用和治疗中断情况来自瑞典的原始模型。对德国医疗保健系统的资源使用和成本的输入因素进行了估计和调整。使用成本效益散点图进行了概率敏感性分析（PSA），以直观显示结果的稳健性。
在基础病例情景中，PLAI在获得的质量调整生命年（QALYs）和避免复发方面优于RLAI。相对于所有其他治疗策略，在基础病例情景中，PLAI在获得QALYs和避免复发方面更有效，但在5年的时间范围内会导致更高的治疗成本。结果在PSA中进行了测试。例如，如果假设成本效益阈值为<30,000欧元，那么在获得QALYs方面，与RLAI相比，PLAI在约92.5%的病例中可被认为具有成本效益，在避免复发方面，在78.6%的病例中可被认为具有成本效益。与OLAI相比，在获得QALYs方面，在约94.4%的病例中可被认为具有成本效益，在避免复发方面，在99.9%的病例中可被认为具有成本效益。将PLAI与癸酸珠氯噻醇进行比较，在获得QALYs方面，在约90.4%的病例中可被认为具有成本效益，在避免复发方面，在所有病例中可被认为具有成本效益。
在基础病例情景中，PLAI优于RLAI，并且与其他治疗策略相比，PLAI已被证明更有效，但会导致更高的成本。
