Jukic Vlado, Jakovljevic Miro, Filipcic Igor, Herceg Miroslav, Silic Ante, Tomljanovic Tatjana, Zilbershtein Roman, Jensen Rasmus C D, Hemels Michiel E H, Einarson Thomas R
University Psychiatric Hospital "Vrapce," Zagreb, Croatia.
Department of Psychiatry, University Hospital of Zagreb, Zagreb, Croatia.
Value Health Reg Issues. 2013 Sep-Oct;2(2):181-188. doi: 10.1016/j.vhri.2013.06.008. Epub 2013 Sep 13.
As a nation with a developing economy, Croatia is faced with making choices between pharmaceutical products, including depot injectable antipsychotics. We conducted a pharmacoeconomic analysis to determine the cost-effectiveness of atypical depots in Croatia.
A 1-year decision-analytic framework modeled drug use. We determined the average direct cost to the Croatian Institute for Health Insurance of using depot formulations of paliperidone palmitate long-acting injectable (PP-LAI), risperidone LAI (RIS-LAI), or olanzapine LAI (OLZ-LAI). An expert panel plus literature-derived clinical rates populated the core model, along with costs adjusted to 2012 by using the Croatian consumer price index. Clinical outcomes included quality-adjusted life-years, hospitalization rates, emergency room treatment rates, and relapse days. Robustness of results was examined with one-way sensitivity analyses on important inputs; overall, all inputs were varied over 10,000 simulations in a Monte Carlo analysis.
Costs (quality-adjusted life-years) per patient were €5061 (0.817) for PP-LAI, €5168 (0.807) for RIS-LAI, and €6410 (0.812) for OLZ-LAI. PP-LAI had the fewest relapse days, emergency room visits, and hospitalizations. Results were sensitive against RIS-LAI with respect to drug costs and adherence rates, but were generally robust overall, dominating OLZ-LAI in 77.3% and RIS-LAI in 56.8% of the simulations.
PP-LAI dominated the other drugs because it had the lowest cost and best clinical outcomes. Compared with depots of olanzapine and risperidone and oral olanzapine, PP-LAI was the cost-effective atypical LAI for treating chronic schizophrenia in Croatia. Using depot paliperidone in place of either olanzapine or risperidone would reduce the overall costs of caring for these patients.
作为一个经济正在发展的国家，克罗地亚面临着在包括长效注射用抗精神病药物在内的药品之间做出选择的问题。我们进行了一项药物经济学分析，以确定非典型长效注射剂在克罗地亚的成本效益。
一个为期1年的决策分析框架对药物使用情况进行了建模。我们确定了克罗地亚健康保险机构使用棕榈酸帕利哌酮长效注射剂（PP-LAI）、利培酮长效注射剂（RIS-LAI）或奥氮平长效注射剂（OLZ-LAI）的平均直接成本。一个专家小组加上从文献中得出的临床发生率构成了核心模型，同时使用克罗地亚消费者价格指数将成本调整到2012年的水平。临床结果包括质量调整生命年、住院率、急诊室治疗率和复发天数。通过对重要输入进行单向敏感性分析来检验结果的稳健性；总体而言，在蒙特卡洛分析中，所有输入在10000次模拟中都有所变化。
每位患者的成本（质量调整生命年），PP-LAI为5061欧元（0.817），RIS-LAI为5168欧元（0.807），OLZ-LAI为6410欧元（0.812）。PP-LAI的复发天数、急诊室就诊次数和住院次数最少。结果在药物成本和依从率方面对RIS-LAI敏感，但总体上通常较为稳健，在77.3%的模拟中优于OLZ-LAI，在56.8%的模拟中优于RIS-LAI。
PP-LAI优于其他药物，因为它成本最低且临床结果最佳。与奥氮平和利培酮的长效注射剂以及口服奥氮平相比，PP-LAI是克罗地亚治疗慢性精神分裂症的具有成本效益的非典型长效注射剂。使用棕榈酸帕利哌酮长效注射剂替代奥氮平或利培酮将降低护理这些患者的总体成本。
