Chen Chaoxin, Chen Tingting, Ke Zhongling, Wu Yi, Liu Maobai, Chen Yanhui, Zheng Bin
Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, 350001, China.
Department of Pharmacy, Fujian Obstetrics and Gynecology Hospital, Fuzhou, 350001, China.
Child Adolesc Psychiatry Ment Health. 2024 Aug 7;18(1):97. doi: 10.1186/s13034-024-00786-0.
Oral aripiprazole exhibits favorable clinical efficacy and safety in the suppression of tics in children and adolescents with tic disorders. This study aims to evaluate and compare the cost-effectiveness of high-dose and low-dose aripiprazole in children and adolescents with tic disorders from the perspective of the Chinese healthcare system.
A questionnaire survey was conducted on 146 patients with tic disorders, of whom 144 completed EQ-5D-Y and YGTSS. Four models were built to convert YGTSS onto EQ-5D-Y utility using two mapping algorithms. We constructed a decision tree model containing efficacy and safety to compare the cost-effectiveness of high-dose and low-dose aripiprazole based on our mapping function.
The GLM with model 1 (YGTSS total tic scores) was selected as the preferred function in our decision tree model. The base case cost-effectiveness analysis showed that compared to low-dose aripiprazole, high-dose aripiprazole improves effectiveness by 0.001QALYs and increases the overall cost by $197.99, resulting in an ICER of $174339.22 per QALY, which exceeds three times the gross domestic product per capita. Hence, high-dose aripiprazole is not likely to be a cost-effective option for child patients with tic disorders. One-way sensitivity analysis and probabilistic sensitivity analysis showed that these results is robust.
On the basis of currently available data, low-dose aripiprazole may be a safe, effective, and economical dosage for children and adolescents with tic disorders.
The main limitation of our study is the lack of utility directly used for cost-effectiveness analysis. We obtained the utility of patients with tic disorders indirectly by the mapping function. This may introduce some bias and uncertainty. And it is a limitation to use the direct medical costs of Germany in our model. Although we converted it to the equivalent value of China using purchasing power parities, caution should be exercised when interpreting the results of this study.
口服阿立哌唑在抑制抽动障碍儿童和青少年的抽动方面显示出良好的临床疗效和安全性。本研究旨在从中国医疗保健系统的角度评估和比较高剂量和低剂量阿立哌唑治疗抽动障碍儿童和青少年的成本效益。
对146例抽动障碍患者进行问卷调查，其中144例完成了EQ-5D-Y和YGTSS。使用两种映射算法建立了四个模型，将YGTSS转换为EQ-5D-Y效用值。我们构建了一个包含疗效和安全性的决策树模型，以根据我们的映射函数比较高剂量和低剂量阿立哌唑的成本效益。
在我们的决策树模型中，选择模型1（YGTSS总抽动评分）的广义线性模型作为首选函数。基础病例成本效益分析表明，与低剂量阿立哌唑相比，高剂量阿立哌唑可使效果提高0.001个质量调整生命年（QALY），并使总成本增加197.99美元，导致每QALY的增量成本效果比（ICER）为174339.22美元，超过人均国内生产总值的三倍。因此，高剂量阿立哌唑对于抽动障碍儿童患者不太可能是具有成本效益的选择。单向敏感性分析和概率敏感性分析表明，这些结果是稳健的。
根据现有数据，低剂量阿立哌唑可能是治疗抽动障碍儿童和青少年安全、有效且经济的剂量。
我们研究的主要局限性是缺乏直接用于成本效益分析的效用值。我们通过映射函数间接获得抽动障碍患者的效用值。这可能会引入一些偏差和不确定性。并且在我们的模型中使用德国的直接医疗成本是一个局限性。尽管我们使用购买力平价将其转换为中国的等效值，但在解释本研究结果时应谨慎。
