Tazi Ahmed, Errachidi Faouzi, Sonawane Dipesh, Tahri Ghizlane, Rao Sameer, Mehta Suyog
Department of Pharmacology & Biology, Sidi Mohamed Ben Abdellah University (USMBA), Fez, Morocco.
Department of Medical Affairs and Clinical Research, Sun Pharmaceutical Industries Limited, Western Express Highway, Goregaon East (Near JVLR Junction), Mumbai, 400 063, India.
Ann Gen Psychiatry. 2024 Sep 18;23(1):33. doi: 10.1186/s12991-024-00516-y.
Antipsychotic medications are the primary treatment for schizophrenia, with olanzapine being an effective medication for schizophrenia. The economic cost for each individual with schizophrenia is high, with antipsychotic medication being a major expense. This study aims to develop an economic decision model that compares different treatment options for schizophrenia patients, including olanzapine Orally Dispersible Tablets (ODT), olanzapine [ODT + Standard Oral Tablet (SOT)], risperidone (ODT + SOT), and aripiprazole (ODT + SOT), to determine their cost-effectiveness with an objective to optimize healthcare resource allocation in Morocco.
The study used published medical literature and a clinical expert panel to develop a decision analytic model. This model was designed to capture parameters such as adherence levels, treatment discontinuation, relapse with and without hospitalization, quality-adjusted life years (QALYs), treatment-related adverse events, healthcare resource utilization, and associated costs. The main outcomes of interest included the total annual direct cost per treatment, QALYs, and incremental cost-effectiveness ratio (ICER) per 1 QALY gained. One-way and probabilistic sensitivity analyses were employed to account for parameter uncertainty.
According to the simulation model, the ODT and ODT + SOT as a group form of olanzapine was the most effective treatment option in terms of the lowest percentages of inpatient relapse, and patients who remained stable (11% and 79% respectively) than risperidone (19% and 62% respectively) and aripiprazole ODT (26% and 50% respectively) and ODT + SOT formulation groups. Olanzapine (ODT + SOT) therapy group was cost-effective when compared to the combined group of ODT + SOT forms of risperidone [ICER: Moroccan Dirham (MAD) 103,907], and aripiprazole (ICER: MAD 65,047). Additionally, olanzapine ODT was found to be cost-effective compared to olanzapine SOT with an ICER of MAD 3921, risperidone ODT with an ICER of MAD 1,02,298, risperidone SOT with an ICER of MAD 31,088, and aripiprazole ODT or SOT formulations. All the above ICERs fall under the willingness-to-pay threshold in Morocco of MAD 250,832.40. Sensitivity analyses confirmed the reliability of the findings.
The model concluded that olanzapine ODT is the most cost-effective first-line treatment option for schizophrenia in Morocco when compared to other atypical antipsychotic medications in ODT and SOT formulations.
抗精神病药物是精神分裂症的主要治疗手段，奥氮平是治疗精神分裂症的一种有效药物。精神分裂症患者的个人经济成本很高，抗精神病药物是一项主要开支。本研究旨在开发一种经济决策模型，比较精神分裂症患者的不同治疗方案，包括奥氮平口腔崩解片（ODT）、奥氮平[ODT + 标准口服片（SOT）]、利培酮（ODT + SOT）和阿立哌唑（ODT + SOT），以确定它们的成本效益，目标是优化摩洛哥的医疗资源分配。
该研究利用已发表的医学文献和一个临床专家小组来开发一个决策分析模型。该模型旨在获取诸如依从性水平、治疗中断、有无住院的复发情况、质量调整生命年（QALY）、治疗相关不良事件、医疗资源利用及相关成本等参数。主要关注的结果包括每种治疗的年度总直接成本、QALY以及每获得1个QALY的增量成本效益比（ICER）。采用单向和概率敏感性分析来考虑参数的不确定性。
根据模拟模型，奥氮平的ODT和ODT + SOT组合形式在住院复发率最低方面是最有效的治疗方案，与利培酮（分别为19%和62%）、阿立哌唑ODT（分别为26%和50%）以及ODT + SOT剂型组相比，病情保持稳定的患者比例分别为11%和79%。与利培酮（ICER：摩洛哥迪拉姆（MAD）103,907）和阿立哌唑（ICER：MAD 65,047）的ODT + SOT组合组相比，奥氮平（ODT + SOT）治疗组具有成本效益。此外，发现奥氮平ODT与奥氮平SOT相比具有成本效益，ICER为MAD 3921，与利培酮ODT相比ICER为MAD 102,298，与利培酮SOT相比ICER为MAD 31,088，与阿立哌唑ODT或SOT剂型相比也具有成本效益。上述所有ICER均低于摩洛哥250,832.40 MAD的支付意愿阈值。敏感性分析证实了研究结果的可靠性。
该模型得出结论，与ODT和SOT剂型的其他非典型抗精神病药物相比，奥氮平ODT是摩洛哥精神分裂症最具成本效益的一线治疗方案。
