IQVIA, Corporate Village, Davos Building, Da Vincilaan 7, 1930 Zaventem, Belgium.
Department of Psychiatry, University Hospital of Saint-Etienne, TAPE Laboratory, EA7423, Jean Monnet University, 42100 Saint-Étienne, France.
Encephale. 2019 Dec;45(6):459-467. doi: 10.1016/j.encep.2019.03.001. Epub 2019 Sep 18.
Schizophrenia entails a considerable humanistic and economic burden. Improved treatment continuity to antipsychotic therapy is paramount to reduce the risk of relapse. The novel three-monthly paliperidone palmitate treatment (PP3M) offers the longest dosing interval currently available in France. This study assesses its cost-effectiveness, versus the currently available one-monthly long-acting treatment (PP1M) in French schizophrenic patients.
A Markov model with monthly cycles was developed and adapted. It encompassed [a] administration of PP3M or PP1M in first-line, [b] a period where the patient does not receive any active treatment, and [c] a follow-up treatment line consisting of a treatment mix reflecting French clinical practice. Relapse rates in first-line were based on a pivotal non-inferiority head-to-head trial, and treatment discontinuation rates were based on French real-world data. Accounting for differences in drug exposure, time-dependent monthly relapse rates were applied following discontinuation to first line. The impact of a less frequent injection schedule for PP3M in QoL was accounted for through the application of a utility differential. The collective perspective was adopted throughout a 5-year time horizon. Four percent discount rates were applied on costs and outcomes.
PP3M was dominant when compared to PP1M, featuring an incremental QALY of 0.123 and a cost saving effect (-669€) resulting from reduced therapy costs (drug acquisition, administration and monitoring) and relapse-related costs. Sensitivity analysis supported the robustness of the results.
With slightly better QALY outcomes and a cost-saving effect when compared to PP1M, introducing PP3M is an improvement to the current treatment in France.
精神分裂症带来了巨大的人文和经济负担。改善抗精神病药物治疗的连续性对于降低复发风险至关重要。新型三个月帕利哌酮棕榈酸酯治疗（PP3M）提供了目前在法国可用的最长给药间隔。本研究评估了其与目前可用的每月长效治疗（PP1M）相比在法国精神分裂症患者中的成本效益。
开发并改编了一个每月周期的马尔可夫模型。它包括 [a] 在一线使用 PP3M 或 PP1M，[b] 患者不接受任何积极治疗的时期，以及 [c] 由反映法国临床实践的治疗组合组成的后续治疗线。一线治疗的复发率基于一项关键性非劣效性头对头试验，停药率基于法国真实世界数据。考虑到药物暴露的差异，停药后根据每月复发率进行时间依赖性应用。PP3M 较少的注射方案对 QoL 的影响通过应用效用差异来考虑。整个 5 年时间范围内采用集体观点。对成本和结果应用 4%的贴现率。
与 PP1M 相比，PP3M 具有优势，其增量 QALY 为 0.123，并且由于治疗成本（药物获取、管理和监测）和与复发相关的成本降低，具有成本节约效果（节省 669 欧元）。敏感性分析支持结果的稳健性。
与 PP1M 相比，PP3M 具有稍好的 QALY 结果和成本节约效果，在法国引入 PP3M 是对当前治疗的改进。
