长效非典型抗精神病药物治疗芬兰急性复发慢性精神分裂症的药物经济学
Pharmacoeconomics of long-acting atypical antipsychotics for acutely relapsed chronic schizophrenia in Finland.
作者信息
Einarson Thomas R, Pudas Hanna, Goswami Pushpendra, van Impe Kristel, Bereza Basil G
机构信息
a a Leslie Dan Faculty of Pharmacy, University of Toronto , Canada.
b b Janssen-Cilag , Espoo , Finland.
出版信息
J Med Econ. 2016;19(2):111-20. doi: 10.3111/13696998.2015.1100115. Epub 2015 Nov 11.
BACKGROUND
Atypical long-acting injectable (LAI) antipsychotics are increasingly available for treating chronic schizophrenia in patients chronically non-adherent to prescribed regimens. Few economic studies have compared these products.
PURPOSE
To determine the cost-effectiveness of aripiprazole (ARI-LAI), paliperidone (PP-LAI), olanzapine (OLZ-LAI), and risperidone (RIS-LAI) in patients with chronic schizophrenia in Finland.
METHODS
A 1-year decision tree model was adapted with guidance from an expert panel. Patients started hospitalized in relapse; those who responded continued treatment, others were switched to secondary drugs, then clozapine in the event of 2nd line failure. Rates of adherence, stable disease, relapse, and hospitalization were taken from pivotal trials, and utilities from published research. Included were direct costs paid by the Finnish Ministry of Health, in 2015 euros. Outcomes included quality-adjusted life-years (QALYs), hospitalization rates, and rates of relapse not requiring hospitalization. Model robustness was assessed using a series of 1-way and multivariate sensitivity analyses.
RESULTS
Expected costs were lowest for PP-LAI at 41,148€, followed by 41,543€ for ARI-LAI, 42,067€ for RIS-LAI and 45,406€ for OLZ-LAI. Respective QALYs were 0.683, 0.671, 0.666, and 0.672. Re-hospitalization rates and non-admitted relapses were 23.6% and 3.9% for PP-LAI, 28.5% and 4.1% for ARI-LAI, 28.8% and 5.0% for RIS-LAI, 28.3% and 5.2% for OLZ-LAI. PP-LAI treatment was associated with the most days with stable disease (132.0), followed by OLZ-LAI (125.5), ARI-LAI (122.6), and RIS-LAI (114.4). Sensitive inputs between PP-LAI and ARI-LAI included rates of adherence, dropouts, and relapses plus drug prices; dropout and relapse rates for RIS-LAI; OLZ-LAI results were insensitive. In probability sensitivity analyses, PP-LAI dominated ARI-LAI in 75.8% of the 10,000 iterations, RIS-LAI in 83.1% and OLZ-LAI in 95.7%.
CONCLUSIONS
PP-LAI dominated the other atypicals. It appears to be the preferred option for treating chronic relapsing schizophrenia.
背景
非典型长效注射用抗精神病药物越来越多地用于治疗长期不依从规定治疗方案的慢性精神分裂症患者。很少有经济学研究对这些产品进行比较。
目的
确定阿立哌唑长效注射剂（ARI-LAI）、帕利哌酮长效注射剂（PP-LAI）、奥氮平长效注射剂（OLZ-LAI）和利培酮长效注射剂（RIS-LAI）在芬兰慢性精神分裂症患者中的成本效益。
方法
在一个专家小组的指导下，采用了一个1年的决策树模型。患者复发时开始住院治疗；有反应的患者继续治疗，其他患者改用二线药物，如果二线治疗失败则使用氯氮平。依从率、病情稳定率、复发率和住院率来自关键试验，效用值来自已发表的研究。纳入的是芬兰卫生部支付的直接费用，以2015年欧元计。结果包括质量调整生命年（QALY）、住院率和无需住院的复发率。使用一系列单因素和多因素敏感性分析评估模型的稳健性。
结果
PP-LAI的预期成本最低，为41,148欧元，其次是ARI-LAI的41,543欧元、RIS-LAI的42,067欧元和OLZ-LAI的45,406欧元。各自的QALY分别为0.683、0.671、0.666和0.672。PP-LAI的再次住院率和未住院复发率分别为23.6%和3.9%，ARI-LAI为28.5%和4.1%，RIS-LAI为28.8%和5.0%，OLZ-LAI为28.3%和5.2%。PP-LAI治疗与病情稳定的天数最多相关（132.0天），其次是OLZ-LAI（125.5天）、ARI-LAI（122.6天）和RIS-LAI（114.4天）。PP-LAI和ARI-LAI之间的敏感输入包括依从率、退出率和复发率以及药品价格；RIS-LAI的退出率和复发率；OLZ-LAI的结果不敏感。在概率敏感性分析中，在10,000次迭代中，PP-LAI在75.8%的情况下优于ARI-LAI，在83.1%的情况下优于RIS-LAI，在95.7%的情况下优于OLZ-LAI。
结论
PP-LAI优于其他非典型药物。它似乎是治疗慢性复发性精神分裂症的首选药物。
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