目的:评价不同药物给药方案治疗精神分裂症的经济性,为我国临床用药选择提供参考依据.方法:基于Markov模型模拟一组精神分裂症患者在3种健康状态(稳定、复发、死亡)中的进展,从中国医疗系统角度,收集药品价格和复发患者住院成本费用数据.估算每日口服药物(奥氮平)以及每隔0.5个月(注射用利培酮微球Ⅱ)、1个月(棕榈酸帕利哌酮注射液1M)、3个月(棕榈酸帕利哌酮注射液3M)、6个月(棕榈酸帕利哌酮注射液6M)注射1次药物,共5种给药方案治疗精神分裂症的5年累积成本和健康效果,并计算增量成本效果比,通过敏感性分析评估结果的稳健性.结果:每日口服给药治疗精神分裂症是成本最低的方案,每1个月注射1次的治疗方案效果最好.每0.5和6个月注射1次的方案比每1个月注射1次成本更高但效果更差.与每日口服给药相比,每3个月注射1次每挽救1个质量调整生命年(quality adjus-ted life year,QALY)需花费66078.9元,每1个月注射1次每挽救1个QALY需花费143 417.8元,敏感性分析提示模型结果具有较好的稳定性.结论:在2022年中国人均3倍GDP(257 094.0元)的支付意愿阈值下,每1个月注射1次和每3个月注射1次的治疗方案均具成本效果,其中每3个月注射1次的治疗方案最具成本效果,本研究可为我国精神分裂症的临床治疗提供证据.
Cost-effectiveness analysis on 5 strategies of treatment for schizophrenia in China
Objective:To evaluate the cost-effectiveness of different strategies of treatment for schizophrenia and to provide evidence for clinical decision-making in China.Methods:A Markov model with three health states(stable,relapse,and dead)was developed to simulate the progression of a cohort of patients with schizophrenia.From the perspective of healthcare system,the medication costs and inpatient costs were collected.The cumulative costs and health outcomes over 5 years were evaluated for the treatment strategies with daily oral administration(Olanzapine),as well as one injection every half(Risperidone for Depot Suspension),one(Paliperidone Palmitate Injection 1M),three(Paliperidone Palmitate Injection 3M),and six months(Paliperidone Palmitate Injection 6M).The incremental cost-effectiveness ratios were calculated for the comparison of different strategies for treating schizophrenia.The robustness of results was assessed by sensitivity analyses.Results:Daily oral administration was the least costly,while every-1-month injection was the most effective.The strategies of giving one injection every half month and every six months were the more costly and less effective than every-1-month injection strategy.The cost per QALY gained was 66 078.9 CNY for every-3-month injection strategy and that for every-1-month injection strategy was 143 417.8 CNY,compared with the daily oral medication.Sensitivity analysis suggested good reliability of the model outcomes.Conclusion:With the threshold of three times per capita Gross Domestic Product(257 094.0 CNY)in 2022 in China,the treatment strategy of giving every-1-month injection strategy and every-3-month injection strategy are cost-effective,among which the strategy of giving once every three months is the most cost-effective.The results might provide evidence for clinical treatment of schizophrenia in China.
schizophreniatreatment strategycost-effectiveness analysisMarkov model
NETL
NSTL
万方数据
