Evidera, 500 Totten Pond Road, Waltham, MA, 02451, USA.
Alkermes, Inc, 852 Winter Street, Waltham, MA, 02451-1420, USA.
Adv Ther. 2022 Sep;39(9):3933-3956. doi: 10.1007/s12325-022-02232-z. Epub 2022 Jul 18.
Schizophrenia is a chronic mental disorder associated with substantial morbidity and mortality affecting 0.25-1.6% of adults in the USA. Antipsychotic treatment is the standard of care for schizophrenia, but real-world treatment patterns and associated costs have not been systematically reviewed.
We conducted a systematic review to summarize treatment patterns and associated costs related to oral antipsychotic treatment of patients with schizophrenia in the USA.
We searched Medline (via PubMed) and Embase to identify relevant observational studies published from January 1, 2008, to June 1, 2018; costs were converted to 2018 US dollars.
Observational, real-world studies reporting on patterns of treatment and/or associated costs for adult patients with schizophrenia treated with oral antipsychotics in the USA were included.
Eighty-one studies were identified. Frequently prescribed oral second-generation antipsychotics were olanzapine (up to 50.9%), risperidone (up to 40.0%), and quetiapine (up to 30.7%). Suboptimal adherence was common across studies. Antipsychotic switching occurred in about half of patients, while antipsychotic combination therapy occurred in nearly 30%; all were associated with increased medication-related costs. Mean annual direct medical costs differed by treatment, with reported costs of $17,115 to $26,138 for patients treated with olanzapine, $18,395 for risperidone, and $17,656 to $28,101 for quetiapine.
This systematic review is limited by the variations in definitions of schizophrenia-related clinical terms used between studies and by the inclusion of studies focused on only the US health care system.
In the treatment of schizophrenia, suboptimal adherence, antipsychotic switching, and antipsychotic augmentation were all associated with high costs of care in comparison to patients who were adherent and did not require antipsychotic switching or augmentation. These findings illustrate the need for the development of new treatments that address efficacy and adherence challenges of currently available therapies.
精神分裂症是一种慢性精神障碍，其发病率和死亡率相当高，在美国约有 0.25%-1.6%的成年人受其影响。抗精神病药物治疗是精神分裂症的标准治疗方法，但真实世界的治疗模式和相关费用尚未得到系统评估。
我们进行了一项系统综述，以总结美国精神分裂症患者口服抗精神病药物治疗的治疗模式和相关费用。
我们检索了 Medline（通过 PubMed）和 Embase，以确定 2008 年 1 月 1 日至 2018 年 6 月 1 日期间发表的与美国接受口服抗精神病药物治疗的成年精神分裂症患者的治疗模式和/或相关费用相关的观察性研究；费用已转换为 2018 年的美元。
纳入了在美国接受口服抗精神病药物治疗的成年精神分裂症患者的治疗模式和/或相关费用的观察性、真实世界研究。
共确定了 81 项研究。经常开处方的第二代口服抗精神病药物为奥氮平（高达 50.9%）、利培酮（高达 40.0%）和喹硫平（高达 30.7%）。研究中普遍存在不依从治疗的情况。约有一半的患者进行了抗精神病药转换，近 30%的患者进行了抗精神病药联合治疗；所有这些均与增加药物相关费用有关。根据治疗方法的不同，患者的平均年直接医疗费用也有所不同，接受奥氮平治疗的患者报告的费用为 17115 美元至 26138 美元，利培酮为 18395 美元，喹硫平为 17656 美元至 28101 美元。
本系统评价受研究间用于描述与精神分裂症相关的临床术语的定义差异以及仅关注美国医疗保健系统的研究的纳入限制。
在精神分裂症的治疗中，与依从性好且无需进行抗精神病药物转换或增效治疗的患者相比，药物依从性差、抗精神病药物转换和增效治疗均与较高的治疗费用相关。这些结果表明，需要开发新的治疗方法来解决现有治疗方法在疗效和依从性方面的挑战。
