PMID- 18947458
OWN - NLM
STAT- MEDLINE
DCOM- 20110531
LR  - 20191210
IS  - 1473-4877 (Electronic)
IS  - 0300-7995 (Linking)
VI  - 24
IP  - 11
DP  - 2008 Nov
TI  - Cost-effectiveness of atypical antipsychotics for the management of schizophrenia 
      in the UK .
PG  - 3275-85
LID - 10.1185/03007990802507547 [doi]
AB  - 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  pound257 
      (incremental cost/QALY:  pound9,440). Aripiprazole followed by risperidone had the 
      greatest probability among evaluated sequences of being cost-effective at a 
      threshold of > pound10,000/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.
FAU - Davies, Andrew
AU  - Davies A
AD  - Oxford Outcomes, Oxford, UK. andy.davies@oxfordoutcomes.com
FAU - Vardeva, Kawitha
AU  - Vardeva K
FAU - Loze, Jean-Yves
AU  - Loze JY
FAU - L'italien, Gilbert J
AU  - L'italien GJ
FAU - Sennfalt, Karin
AU  - Sennfalt K
FAU - Baardewijk, Marc van
AU  - Baardewijk Mv
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20081022
PL  - England
TA  - Curr Med Res Opin
JT  - Current medical research and opinion
JID - 0351014
RN  - 0 (Antipsychotic Agents)
RN  - 0 (Piperazines)
RN  - 0 (Quinolones)
RN  - 12794-10-4 (Benzodiazepines)
RN  - 82VFR53I78 (Aripiprazole)
RN  - N7U69T4SZR (Olanzapine)
SB  - IM
MH  - Algorithms
MH  - Antipsychotic Agents/adverse effects/*economics/*therapeutic use
MH  - Aripiprazole
MH  - Benzodiazepines/adverse effects/economics/therapeutic use
MH  - Clinical Trials, Phase I as Topic/economics/statistics & numerical data
MH  - Cost-Benefit Analysis
MH  - Decision Support Techniques
MH  - Follow-Up Studies
MH  - Health Care Costs
MH  - Health Resources/economics/statistics & numerical data
MH  - Humans
MH  - Olanzapine
MH  - Patient Acceptance of Health Care
MH  - Piperazines/adverse effects/economics/therapeutic use
MH  - Quality-Adjusted Life Years
MH  - Quinolones/adverse effects/economics/therapeutic use
MH  - Randomized Controlled Trials as Topic/economics/statistics & numerical data
MH  - Schizophrenia/*drug therapy/*economics/epidemiology
MH  - United Kingdom/epidemiology
EDAT- 2008/10/25 09:00
MHDA- 2011/06/01 06:00
CRDT- 2008/10/25 09:00
PHST- 2008/10/25 09:00 [pubmed]
PHST- 2011/06/01 06:00 [medline]
PHST- 2008/10/25 09:00 [entrez]
AID - 4757f [pii]
AID - 10.1185/03007990802507547 [doi]
PST - ppublish
SO  - Curr Med Res Opin. 2008 Nov;24(11):3275-85. doi: 10.1185/03007990802507547. Epub 
      2008 Oct 22.