Lubinga Solomon J, Mutamba Byamah B, Nganizi Angelo, Babigumira Joseph B
Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Seattle, Washington, USA.
Global Medicines Program, Department of Global Health, University of Washington, Seattle, Washington, USA.
Appl Health Econ Health Policy. 2015 Oct;13(5):493-506. doi: 10.1007/s40258-015-0176-3.
Reductions in prices following the expiry of patents on second-generation antipsychotics means that they could be made available to patients with schizophrenia in low-income countries. In this study we examine the cost effectiveness of antipsychotics for schizophrenia in Uganda.
We developed a decision-analytic 10-state Markov model to represent the clinical and treatment course of schizophrenia and the experience of the average patient within the Uganda healthcare system. The model was run for a base population of 25-years-old patients attending Butabika National Referral Mental Hospital, in annual cycles over a lifetime horizon. Parameters were derived from a primary chart abstraction study, a local community pharmacy survey, published literature, and expert opinion where necessary. We computed mean disability-adjusted life-years (DALYs) and costs (in US$ 2012) for each antipsychotic, incremental cost, and DALYs averted as well as incremental cost-effectiveness ratios (ICERs).
In the base-case analysis, mean DALYs were highest with chlorpromazine (27.608), followed by haloperidol (27.563), while olanzapine (27.552) and risperidone had the lowest DALYs (27.557). Expected costs were highest with quetiapine (US$4943), and lowest with risperidone (US$4424). Compared to chlorpromazine, haloperidol was a dominant option (i.e. it was less costly and more effective); and risperidone was dominant over both haloperidol and quetiapine. The ICER comparing olanzapine to risperidone was US$5868 per DALY averted.
When choosing between first-generation antipsychotics, clinicians should consider haloperidol as the first-line agent for schizophrenia. However, overall, risperidone is a cost-saving strategy; policymakers should consider its addition to essential medicines lists for treatment of schizophrenia in Uganda.
第二代抗精神病药物专利到期后价格降低，这意味着低收入国家的精神分裂症患者也能够使用这些药物。在本研究中，我们考察了乌干达抗精神病药物治疗精神分裂症的成本效益。
我们开发了一个决策分析十状态马尔可夫模型，以呈现精神分裂症的临床和治疗过程以及乌干达医疗系统中普通患者的经历。该模型以在布塔比卡国家转诊精神病医院就诊的25岁患者为基础人群运行，在整个生命周期内按年度循环。参数来自一项原始病历摘要研究、一项当地社区药房调查、已发表的文献，并在必要时参考专家意见。我们计算了每种抗精神病药物的平均伤残调整生命年（DALY）和成本（2012年美元）、增量成本和避免的DALY以及增量成本效益比（ICER）。
在基础病例分析中，氯丙嗪的平均DALY最高（27.608），其次是氟哌啶醇（27.563），而奥氮平（27.552）和利培酮的DALY最低（27.557）。预期成本喹硫平最高（4943美元），利培酮最低（4424美元）。与氯丙嗪相比，氟哌啶醇是一个占优选择（即成本更低且更有效）；利培酮优于氟哌啶醇和喹硫平两者。奥氮平与利培酮相比的ICER为每避免一个DALY 5868美元。
在选择第一代抗精神病药物时，临床医生应将氟哌啶醇视为精神分裂症的一线用药。然而，总体而言，利培酮是一种节省成本的策略；政策制定者应考虑将其列入乌干达治疗精神分裂症的基本药物清单。
