King's Health Economics (KHE), Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, United Kingdom.
Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom.
PLoS One. 2020 Jul 10;15(7):e0234996. doi: 10.1371/journal.pone.0234996. eCollection 2020.
Numerous economic models have assessed the cost-effectiveness of antipsychotic medications in schizophrenia. It is important to understand what key impacts of antipsychotic medications were considered in the existing models and limitations of existing models in order to inform the development of future models.
This systematic review aims to identify which clinical benefits, clinical harms, costs and cost savings of antipsychotic medication have been considered by existing models, to assess quality of existing models and to suggest good practice recommendations for future economic models of antipsychotic medications.
An electronic search was performed on multiple databases (MEDLINE, EMBASE, PsycInfo, Cochrane database of systematic reviews, The NHS Economic Evaluation Database and Health Technology Assessment database) to identify economic models of schizophrenia published between 2005-2020. Two independent reviewers selected studies for inclusion. Study quality was assessed using the National Institute for Health and Care Excellence (NICE) checklist and the Cooper hierarchy. Key impacts of antipsychotic medications considered by exiting models were descriptively summarised.
Sixty models were included. Existing models varied greatly in key impacts of antipsychotic medication included in the model, especially in clinical outcomes used for assessing reduction in psychotic symptoms and types of adverse events considered in the model. Quality of existing models was generally low due to failure to capture the health and cost impact of adverse events of antipsychotic medications and input data not obtained from best available source. Good practices for modelling antipsychotic medications are suggested.
This review highlights inconsistency in key impacts considered by different models, and limitations of the existing models. Recommendations on future research are provided.
许多经济模型评估了抗精神病药物治疗精神分裂症的成本效益。了解现有模型考虑了哪些抗精神病药物的关键影响以及现有模型的局限性，对于为未来模型提供信息非常重要。
本系统评价旨在确定现有模型考虑了哪些抗精神病药物的临床获益、临床危害、成本和成本节约，评估现有模型的质量，并为未来抗精神病药物经济模型提出良好实践建议。
在多个数据库（MEDLINE、EMBASE、PsycInfo、Cochrane 系统评价数据库、NHS 经济评价数据库和卫生技术评估数据库）中进行了电子检索，以确定 2005 年至 2020 年间发表的抗精神分裂症经济模型。两名独立的审查员选择纳入的研究。使用国家卫生与临床优化研究所 (NICE) 清单和库珀层次结构评估研究质量。对现有模型考虑的抗精神病药物的关键影响进行描述性总结。
共纳入 60 项模型。现有模型在纳入模型的抗精神病药物的关键影响方面差异很大，特别是在用于评估精神症状减轻的临床结果和模型中考虑的不良反应类型方面。由于未能捕捉抗精神病药物不良反应的健康和成本影响以及未从最佳可用来源获取输入数据，现有模型的质量普遍较低。建议了建模抗精神病药物的良好实践。
本综述强调了不同模型考虑的关键影响不一致，以及现有模型的局限性。提供了对未来研究的建议。
