Luo Rui, Lu He, Li Hengfen
Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Department of Radiology, The People's Hospital of Jiawang District of Xuzhou, Xuzhou, Jiangsu, China.
Front Pharmacol. 2023 Aug 3;14:1238028. doi: 10.3389/fphar.2023.1238028. eCollection 2023.
Long-acting injections (LAIs) of paliperidone palmitate have been shown to improve medication adherence and relieve psychotic symptoms. However, the specific cost-utility analysis of these LAIs in schizophrenia in China remains unclear. A multi-state Markov model was constructed to simulate the economic outcomes of patients with schizophrenia in China who received paliperidone palmitate 1-month formulation (PP1M), paliperidone palmitate 3-month formulation (PP3M), and paliperidone extended-release (ER). A cost-utility analysis was conducted, mostly derived from published literature and clinical databases. All costs and utilities were discounted at a rate of 5% per annum. The primary outcome measure was the incremental cost-effectiveness ratios (ICERs). A series of sensitivity analyses were also applied. After 20 years, compared to ER, using PP1M resulted in an increased discounted cost from $36,252.59 to $43,207.28. This increased cost was associated with a gain in quality-adjusted life years (QALYs) from 8.60 to 9.45. As a result, the ICER for PP1M was estimated to be $8,247.46/QALY, which was lower than the willingness-to-pay (WTP) threshold of $12,756.55/QALY. When using PP3M instead of ER, the incremental cost was $768.81 and the incremental utility was 0.88 QALYs, projecting an ICER of $873.13/QALY, which was also lower than the WTP threshold of $12,756.55/QALY. The univariate sensitivity analysis showed that the costs of PP1M, PP3M, and ER had the greatest impact on ICERs. The probability sensitivity analysis (PSA) revealed that when the WTP thresholds were $12,756.55/QALY, the probability of PP1M and PP3M being cost-effective was 59.2% and 66.0%, respectively. From the Chinese healthcare system perspective, PP3M and PP1M are both more cost-effective compared to ER, and PP3M has notable cost-utility advantages over PP1M.
棕榈酸帕利哌酮长效注射剂（LAIs）已被证明可提高药物依从性并缓解精神病症状。然而，这些长效注射剂在中国精神分裂症患者中的具体成本效益分析仍不明确。构建了一个多状态马尔可夫模型，以模拟中国接受棕榈酸帕利哌酮1个月剂型（PP1M）、棕榈酸帕利哌酮3个月剂型（PP3M）和帕利哌酮缓释剂（ER）治疗的精神分裂症患者的经济结局。进行了成本效益分析，主要数据来源于已发表的文献和临床数据库。所有成本和效用均按每年5%的贴现率进行贴现。主要结局指标为增量成本效益比（ICERs）。还进行了一系列敏感性分析。20年后，与ER相比，使用PP1M导致贴现成本从36,252.59美元增加到43,207.28美元。成本增加的同时，质量调整生命年（QALYs）从8.60增加到9.45。因此，PP1M的ICER估计为8,247.46美元/QALY，低于支付意愿（WTP）阈值12,756.55美元/QALY。当使用PP3M代替ER时，增量成本为768.81美元，增量效用为0.88 QALYs，预计ICER为873.13美元/QALY，也低于WTP阈值12,756.55美元/QALY。单因素敏感性分析表明，PP1M、PP3M和ER的成本对ICERs影响最大。概率敏感性分析（PSA）显示，当WTP阈值为12,756.55美元/QALY时，PP1M和PP3M具有成本效益的概率分别为59.2%和66.0%。从中国医疗保健系统的角度来看，与ER相比，PP3M和PP1M都更具成本效益，并且PP3M相对于PP1M具有显著的成本效益优势。
