Cost-Effectiveness of Second-Generation Antipsychotics for the Treatment of Schizophrenia
2014
This article, published in Value in Health, describes a Markov model that compares the cost-effectiveness of alternate sequences of treatment strategies using second-generation antipsychotics (SGAs) for patients with schizophrenia. First-line treatments include one of the four SGAs: olanzapine (OLZ), risperidone (RSP), quetiapine (QTP), and ziprasidone (ZSD). Patients are able switch to another of these antipsychotics as second-line therapy, and only clozapine (CLZ) is allowed as third-line treatment. Model input parameters were obtained from the Clinical Antipsychotic Trial of Intervention Effectiveness (CATIE) study and published literature. The time horizon of the analysis is 10 years and the perspective of the US health care system was adopted.
The study findings indicate that the ZSD-QTP strategy (first-line treatment with ZSD, change to QTP if ZSD is discontinued, and switch to CLZ if QTP is discontinued) is most costly while yielding the greatest QALYs, with an incremental cost-effectiveness ratio (ICER) of $542,500 per QALY gained compared with the ZSD-RSP strategy. However, the ZSD-RSP strategy has an ICER of $5,200/QALY gained versus the RSP-ZSD strategy and has the greatest probability of being cost-effective given a willingness-to-pay threshold between $50,000 and $100,000 per QALY. All other treatment strategies are more costly and less effective than another strategy or combination of other strategies.
Based on these findings the authors conclude that the ZSD-RSP strategy was most cost-effective at a willingness-to-pay threshold between $5,200 and $542,500 per QALY.
Cost-Effectiveness of Second-Generation Antipsychotics for the Treatment of Schizophrenia
Source:
Park T, Kuntz KM. Cost-Effectiveness of Second-Generation Antipsychotics for the Treatment of Schizophrenia. Value in Health 2014; 17 (4): 310-319. http://doi.org/10.1016/j.jval.2014.02.008