Zhou Junwen, Millier Aurelie, Aballea Samuel, Francois Clement, Jin Huajin, Williams Ryan, Lennox Belinda, Tsiachristas Apostolos, Toumi Mondher
Public Health Department, Aix Marseille University, Marseille, France.
Health Economic Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Br J Psychiatry. 2025 Aug;227(2):545-552. doi: 10.1192/bjp.2024.251.
Previous economic evidence about interventions for schizophrenia is outdated, non-transparent and/or limited to a specific clinical context.
We developed a discrete event simulation (DES) model for estimating the cost-effectiveness of interventions in schizophrenia in the UK.
The DES model was developed based on the structure of previous models, populated with demographic, clinical and cost data from the UK, and antipsychotics' effects from recent network meta-analyses. We simulated treatment pathways for patients with first-episode schizophrenia including events such as relapse, remission, treatment discontinuation, cardiovascular disease and death and estimated costs (2020£) taking the National Health Service perspective and quality-adjusted life years (QALYs) over ten years. Using the model, we ranked ten first-line antipsychotics based on their QALYs and cost-effectiveness.
Amisulpride was associated with the highest QALYs, followed by risperidone long-acting injection (LAI), aripiprazole-LAI (6.121, 6.084, 6.070, respectively) and others (5.947-6.058). The most cost-effective antipsychotics were amisulpride, olanzapine and risperidone-LAI, with total probability of rankings of 1, ≤2, ≤3, that is, 95%, 89%, 80%, respectively; meanwhile, the least cost-effective were cariprazine, lurasidone and quetiapine, with total probability of rankings of 10, ≥9, ≥8, that is, 96%, 92%, 81%, respectively. Results were robust across sensitivity analyses and influenced primarily by relapse relevant parameters.
Our findings suggest amisulpride (or risperidone-LAI where oral treatment is inappropriate) as the best overall first-line option based on QALYs and cost-effectiveness. Our ranking may be used to guide decision-making between antipsychotics. Our model is open source and could be applied to the other settings.
先前关于精神分裂症干预措施的经济学证据已过时、不透明且/或局限于特定临床背景。
我们开发了一种离散事件模拟（DES）模型，用于估计英国精神分裂症干预措施的成本效益。
DES模型基于先前模型的结构构建，纳入了来自英国的人口统计学、临床和成本数据，以及近期网络荟萃分析中抗精神病药物的疗效数据。我们模拟了首发精神分裂症患者的治疗路径，包括复发、缓解、治疗中断、心血管疾病和死亡等事件，并从英国国家医疗服务体系的角度估算了成本（2020年英镑）以及十年内的质量调整生命年（QALYs）。使用该模型，我们根据QALYs和成本效益对十种一线抗精神病药物进行了排名。
氨磺必利与最高的QALYs相关，其次是利培酮长效注射剂（LAI）、阿立哌唑-LAI（分别为6.121、6.084、6.070）以及其他药物（5.947 - 6.058）。最具成本效益的抗精神病药物是氨磺必利、奥氮平和利培酮-LAI，其排名的总概率分别为1、≤2、≤3，即分别为95%、89%、80%；同时，最不具成本效益的是卡立普嗪、鲁拉西酮和喹硫平，其排名的总概率分别为10、≥9、≥8，即分别为96%、92%、81%。敏感性分析结果稳健，主要受复发相关参数影响。
我们的研究结果表明，基于QALYs和成本效益，氨磺必利（或在口服治疗不适用时使用利培酮-LAI）是最佳的总体一线选择。我们的排名可用于指导抗精神病药物之间的决策。我们的模型是开源的，可应用于其他环境。
