Office of Health Economics, London, England, UK.
GlobalData, London, England, UK.
Value Health. 2023 Mar;26(3):328-335. doi: 10.1016/j.jval.2022.11.022. Epub 2023 Feb 3.
This article estimates the life-cycle value of risperidone as representative of second-generation antipsychotics (SGA) relative to haloperidol (first-generation antipsychotics).
We estimated the number of patients treated with risperidone in Sweden and the United Kingdom, from 1994 to 2017, using data of usage and volume sales. We collected data from the literature on the effectiveness (quality-adjusted life-years per patient per year), direct costs (health services), and indirect costs (productivity) of risperidone and haloperidol. We proxied the incremental value added by the new class (SGA) using a comparator from the inferior class. Next, we modeled the life-cycle uptake of risperidone to estimate the life-cycle incremental cost (ie, direct, indirect, and medicine costs), incremental quality-adjusted life-years, and net monetary benefit of risperidone. We also assessed the life-cycle distribution of the social surplus between the payer (consumer surplus) and the innovator (producer surplus).
For the United Kingdom, consumer surplus represents around 72% of the total surplus before patent expiration and around 95% after patent expiration. For Sweden, the consumer surplus represents around 94% of the total surplus before patent expiration and around 99% after generic competition.
These results suggest that the value added by SGAs to the system is higher than the expected value estimated using cost-effectiveness analysis at launch. Pricing and reimbursement decisions could recognize the full life cycle of value of innovative medicines. This not only presents a challenge of estimation but also of assessing the appropriate division of shares of social value.
本文旨在评估利培酮（第二代抗精神病药物，SGA）相对于氟哌啶醇（第一代抗精神病药物）的生命周期价值。
我们使用使用量和销售量数据，估计了 1994 年至 2017 年瑞典和英国使用利培酮的患者人数。我们从文献中收集了利培酮和氟哌啶醇的有效性（每位患者每年的质量调整生命年）、直接成本（卫生服务）和间接成本（生产力）的数据。我们使用劣等药物（第一代抗精神病药物）的比较药物来代表新型药物（第二代抗精神病药物）的附加值。然后，我们对利培酮的生命周期采用增量模型来估计利培酮的生命周期增量成本（即直接、间接和药物成本）、增量质量调整生命年和净货币收益。我们还评估了支付者（消费者剩余）和创新者（生产者剩余）之间的社会总剩余在生命周期中的分布。
对于英国，在专利到期前，消费者剩余约占总剩余的 72%，在专利到期后，消费者剩余约占总剩余的 95%。对于瑞典，在专利到期前，消费者剩余约占总剩余的 94%，在专利到期后，消费者剩余约占总剩余的 99%。
这些结果表明，SGA 为系统增加的价值高于上市时使用成本效益分析估计的预期价值。定价和报销决策可以承认创新药物的全部生命周期价值。这不仅提出了估计的挑战，而且还提出了评估社会价值份额的适当划分的挑战。
