Cost-effectiveness of atypical antipsychotics for the management of schizophrenia in the UK
- 2 October 2008
- journal article
- research article
- Published by Informa Healthcare in Current Medical Research and Opinion
- Vol. 24 (11), 3275-3285
- https://doi.org/10.1185/03007990802507547
Abstract
Objective: To evaluate the cost-effectiveness of atypical antipsychotic treatment sequences for the management of stable schizophrenia in the UK. Research design and methods: A Markov model was developed to assess the cost per quality-adjusted life year (QALY) gained from 12 alternative treatment sequences each containing two of four atypical antipsychotics (aripiprazole, olanzapine, quetiapine and risperidone), followed by clozapine. The main model parameters were populated with data from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study and a recent trial comparing aripiprazole with olanzapine. Patients enter the model with stable schizophrenia and may relapse, discontinue or continue and experience adverse events (AEs), or develop diabetes. Population mortality was adjusted for schizophrenia and diabetes. Utility decrements applied to stable schizophrenia, relapse, diabetes and treatment-related AEs were taken from a direct UK utility elicitation study. Resource use and unit costs were taken from published sources. A time horizon of 10 years was adopted. Results are based on 10,000 probabilistic iterations of the model. Results: Aripiprazole followed by risperidone produced the greatest number of QALYs, an additional 0.03 compared with risperidone followed by olanzapine, at an incremental cost of £257 (incremental cost/QALY: £9,440). Aripiprazole followed by risperidone had the greatest probability among evaluated sequences of being cost-effective at a threshold of >£10,000/QALY. All other strategies were dominated by at least one of these strategies. The impact of lower pricing for risperidone (based on generic availability) did not impact results. Conclusions: Modelling the cost-effectiveness of different treatment sequences for stable schizophrenia is appropriate given that patients rarely remain on one treatment for long periods. The treatment sequence aripiprazole followed by risperidone was the most cost-effective option for patients with stable schizophrenia in the UK.Keywords
This publication has 21 references indexed in Scilit:
- Relapse rates in patients with schizophrenia receiving aripiprazole in comparison with other atypical antipsychotics.The Journal of Clinical Psychiatry, 2006
- Effectiveness of long-term aripiprazole therapy in patients with acutely relapsing or chronic, stable schizophrenia: a 52-week, open-label comparison with olanzapinePsychopharmacology, 2006
- Effectiveness of Olanzapine, Quetiapine, Risperidone, and Ziprasidone in Patients With Chronic Schizophrenia Following Discontinuation of a Previous Atypical AntipsychoticAmerican Journal of Psychiatry, 2006
- Effectiveness of Clozapine Versus Olanzapine, Quetiapine, and Risperidone in Patients With Chronic Schizophrenia Who Did Not Respond to Prior Atypical Antipsychotic TreatmentAmerican Journal of Psychiatry, 2006
- The SOHO (Schizophrenia Outpatient Health Outcome) StudyCNS Drugs, 2006
- Relative Risk of Mortality Associated With Diabetes as a Function of Birth WeightDiabetes Care, 2005
- Effectiveness of Antipsychotic Drugs in Patients with Chronic SchizophreniaNew England Journal of Medicine, 2005
- Aripiprazole for the Prevention of Relapse in Stabilized Patients With Chronic SchizophreniaThe Journal of Clinical Psychiatry, 2003
- Causes of the excess mortality of schizophreniaThe British Journal of Psychiatry, 2000
- Excess mortality of schizophreniaThe British Journal of Psychiatry, 1997