抗治疗双相抑郁症患者使用丙克索加心境稳定剂的成本效益：PAX-BD随机对照试验的经济评价

IF 4.9 2区医学 Q1 CLINICAL NEUROLOGY

Journal of affective disorders Pub Date : 2025-07-18 DOI:10.1016/j.jad.2025.119937

Michael Berger , Timea Helter , Lumbini Azim , Thomas Chadwick , Paul Courtney , Tony Fouweather , John Geddes , Paul Hindmarch , Richard Morriss , Paul R.A. Stokes , Stuart Watson , Christopher Weetman , Allan H. Young , R. Hamish McAllister-Williams , Judit Simon

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引用次数: 0

摘要

背景：双相情感障碍（BD）患者经常经历抑郁症状，对现有的治疗方案没有反应。由此给双相障碍患者和社会带来的负担是巨大的。本研究旨在探讨普拉克索联合情绪稳定剂治疗难治性双相情感障碍（TRBD）的成本效益。方法：我们从健康和社会保健（NHS + PSS）和社会角度计算了36名TRBD患者在12周和48周内与安慰剂相比，丙克索的平均增量成本比（ICER）。质量调整生命年（QALY）以EQ-5D-5L作为主要结局指标。我们使用能力幸福感测量（ICECAP-A, OxCAP-MH）来评估结果的稳健性，并使用多重插值和自举来解决数据缺失和小样本量的问题。结果：从NHS + PSS的角度来看，我们发现普拉克索更有效，更节省成本。获得30,000英镑/QALY的成本效益概率分别为70 %（12 周）和90 %（48 周）。从社会角度来看，普拉克索更有效，但也更昂贵，成本-效果的可能性更低（12 周时为33. %，48 周时为47. %）。由于样本量小，平均ICERs的不确定性很大。局限性：PAX-BD试验是在COVID-19大流行期间进行的，并且提前终止，导致大流行背景之外的资源使用的可推广性有限，样本量小。结论：从NHS + PSS的角度来看，普拉克索是一种具有成本效益的TRBD治疗选择，在较长时间内，与健康相关的生活质量和能力幸福感有统计学显著增加。

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Cost-effectiveness of pramipexole in addition to mood stabilisers for patients with treatment-resistant bipolar depression: Economic evaluation of the PAX-BD randomised controlled trial

Background

People with bipolar disorders (BD) frequently experience depressive symptoms that do not respond to available treatment options. The resulting burden for people with BD and society is substantial. This study sought to explore the cost-effectiveness of pramipexole in combination with mood stabilisers for people with treatment-resistant bipolar disorder (TRBD).

Methods

We calculated mean incremental cost-effectiveness ratios (ICER) of pramipexole compared to placebo over 12 and 48 weeks from health and social care (NHS + PSS) and societal perspectives for 36 participants with TRBD. Quality-adjusted life years (QALY) were captured with the EQ-5D-5L as the primary outcome measure. We used capability well-being measures (ICECAP-A, OxCAP-MH) to assess the robustness of the results and multiple imputation and bootstrapping to address missing data and small sample size.

Results

We found that pramipexole is dominantly more effective and cost-saving from the NHS + PSS perspective with 86 % probability of being cost-effective at £30,000/QALY gained over 12 weeks and 93 % over 48 weeks. From the societal perspective, pramipexole was more effective but also more expensive with lower probability of cost-effectiveness (36 % over 12 weeks and 48 % over 48 weeks). Uncertainty around the mean ICERs was substantial due to the small sample size.

Limitations

The PAX-BD trial was conducted during the COVID-19 pandemic and terminated early, resulting in a limited generalizability of resource use outside the pandemic context and a small sample size.

Conclusions

Pramipexole is a cost-effective treatment option for TRBD from the NHS + PSS perspective, with statistically significant increases in health-related quality of life and capability well-being over extended periods.

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来源期刊

Journal of affective disorders 医学-精神病学

CiteScore

10.90

自引率

6.10%

发文量

1319

审稿时长

9.3 weeks

期刊介绍： The Journal of Affective Disorders publishes papers concerned with affective disorders in the widest sense: depression, mania, mood spectrum, emotions and personality, anxiety and stress. It is interdisciplinary and aims to bring together different approaches for a diverse readership. Top quality papers will be accepted dealing with any aspect of affective disorders, including neuroimaging, cognitive neurosciences, genetics, molecular biology, experimental and clinical neurosciences, pharmacology, neuroimmunoendocrinology, intervention and treatment trials.