Cost-effectiveness of second-generation antipsychotics and perphenazine in a randomized trial of treatment for chronic schizophrenia
Cost-effectiveness of second-generation antipsychotics and perphenazine in a randomized trial of treatment for chronic schizophrenia
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DOI：
10.1176/appi.ajp.163.12.2080
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发表时间：
2006-12-01
影响因子：
17.7
通讯作者：
Lieberman, Jeffrey
中科院分区：
文献类型：
--
作者：
Rosenheck, Robert A.;Leslie, Douglas L.;Lieberman, Jeffrey
背景资料：第二代抗精神病药已在很大程度上取代了第一代抗精神病药用于治疗精神分裂症，但尚未尝试进行大规模的成本/效果分析。方法：精神分裂症患者（N = 1，493）被分配接受第一代抗精神病药物（奋乃静）或四种第二代药物（奥氮平、奎替鲁、利培酮或齐拉西酮）中的一种治疗，并随访长达18个月。迟发性运动障碍患者禁止分配至奋乃静组。患者可以在任何时候重新分配到另一种第二代药物，包括氯氮平，但不是奋乃静。成本分析包括药物和卫生服务使用。根据阳性和阴性症状量表（PANSS）子量表评分和副作用评估质量调整生命年（QALY）评分。意向治疗分析包括所有可用的观察结果，按初始药物分配分类，以及将大多数患者重新分配到另一个第二代的成本，仅考虑初始分配药物的治疗。结果如下：尽管QALY评分、PANSS评分和其他生活质量指标表明在18个月内有适度改善，但奋乃静和任何第二代药物之间没有显著差异。奋乃静的平均每月总医疗费用比第二代抗精神病药低300- 600美元（20%-30%），因为药物成本较低。当对所有患者使用最大折扣药品价格时，以及仅包括首次用药治疗期间的观察结果时，成本差异仍然存在。结论：奋乃静治疗的费用低于第二代抗精神病药物治疗，在有效性方面没有显着差异。然而，该试验受到高脱落率的限制，长期的神经和代谢副作用需要进一步研究。
Background: Second-generation antipsychotics have largely replaced first-generation antipsychotics for the treatment of schizophrenia, but a large-scale cost/ effectiveness analysis has not been attempted. Method: Patients with schizophrenia (N = 1,493) were assigned to treatment with a first-generation antipsychotic (perphenazine) or one of four second-generation drugs (olanzapine, quetiapine, risperidone, or ziprasidone) and followed for up to 18 months. Patients with tardive dyskinesia were prohibited from assignment to perphenazine. Patients could be reassigned at any time to another second-generation drug, including clozapine, but not to perphenazine. The cost analysis included medications plus health services use. Quality-adjusted life year (QALY) ratings were assessed on the basis of Positive and Negative Syndrome Scale (PANSS) subscale scores and side effects. An intention-to-treat analysis included all available observations, classified by initial drug assignment, and costs of reassignment of most patients to another second-generation considering only treatment on initially assigned medications. Results: Although QALY ratings, PANSS scores, and other quality of life measures indicated modest improvement over 18 months, there were no significant differences between perphenazine and any second-generation medication. Average total monthly health care costs were $ 300-$ 600 (20%-30%) lower for perphenazine than for second-generation antipsychotics because of lower drug cost. Differences in costs remained when maximally discounted drug prices were used for all patients and when only observations during treatment with the first medication were included. Conclusions: Treatment with perphenazine was less costly than treatment with second-generation antipsychotics with no significant differences in measures of effectiveness. However, the trial was limited by a high dropout rate, and longer-term neurological and metabolic side effects require further study.