阿立哌唑在巴西公共卫生系统中治疗精神分裂症的成本效益和价格

IF 1.6 4区 医学 Q4 HEALTH POLICY & SERVICES
Andre Soares Santos, Kenya Valeria Micaela de Souza Noronha, Monica Viegas Andrade, Cristina Mariano Ruas
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引用次数: 0

摘要

背景:精神分裂症是一种以思维、情感和行为障碍为特征的慢性衰弱性疾病。考虑到精神分裂症抗精神病药物的低有效性和不适当选择的潜在高成本,有必要对补贴的抗精神病药物清单进行系统的成本效益评估,以便为患者提供充分的药物治疗选择和巴西公共卫生系统(SUS)的财务现实。目的:本研究的目的是对巴西用于精神分裂症一线治疗的补贴抗精神病药物和阿立哌唑进行成本-效果分析,探讨阿立哌唑的合理纳入价格。方法:在TreeAge Pro®2009中建立了一个具有季度周期的三年马尔可夫模型,以评估巴西公共卫生系统中用于精神分裂症一线治疗的六种口服抗精神病药物(氟哌啶醇、氯丙嗪、利培酮、喹硫平、齐拉西酮和奥氮平)和口服阿立哌唑的成本效益。结果以质量调整生命年(QALYs)衡量。根据药物在效率前沿的位置和最有效比较物的成本-效果比计算出阿立哌唑的合理价格。结果:采用任何阈值均认为奥氮平具有成本效益。如果要求仿制药的效率低于比较药,奥氮平在0.031美元/毫克以下仍然具有成本效益。阿立哌唑以利培酮为主。敏感性分析显示出重要的不确定性,这是意料之中的。然而,齐拉西酮、喹硫平和效率边界之间存在明显的分离。即使定价为零,阿立哌唑也不被认为具有成本效益:CER = 4102美元,而氟哌啶醇为3945美元,氯丙嗪为3616美元,利培酮为3646美元,奥氮平为3752美元/QALY。结论:奥氮平被认为是巴西精神分裂症一线治疗最具成本效益的药物。阿立哌唑以利培酮为主,与奥氮平相比不具有成本效益。对卫生保健提供和使用的影响:这项工作通过价格调整过程证明,没有可行的价格可以使阿立哌唑在巴西公共卫生系统中纳入精神分裂症一线治疗的成本效益。这种药物在特殊情况下是有用的,因为个体对抗精神病药物反应的可变性是重要的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Cost-effectiveness and Price of Aripiprazole for Schizophrenia in the Brazilian Public Health System

Background: Schizophrenia is a chronic debilitating condition characterized by disorders in thought, affect and behavior. Considering the low effectiveness of antipsychotic drugs for schizophrenia and the potentially high cost of an inadequate choice, a systematic cost-effectiveness evaluation of the list of subsidized antipsychotic drugs is necessary in order to allow an adequate choice of pharmacotherapy for the patient and the financial reality of the Brazilian public health system (SUS).

Objective: The aims of this study are to conduct a cost-effectiveness analysis of the subsidized antipsychotic drugs for the first-line treatment of schizophrenia in Brazil and aripiprazole, and to discuss a reasonable incorporation price for aripiprazole.

Methods: A three-year Markov model with quarterly cycles was developed in TreeAge Pro® 2009 to assess the cost-effectiveness of six listed oral antipsychotic drugs for the first-line treatment of schizophrenia in the Brazilian public health system (haloperidol, chlorpromazine, risperidone, quetiapine, ziprasidone, and olanzapine) and oral aripiprazole. Outcomes were measured in quality-adjusted life years (QALYs). Reasonable prices for aripiprazole were calculated based on the placement of the drug in the efficiency frontier and the cost-effectiveness ratio of the most efficient comparator.

Results: Olanzapine was considered cost-effective adopting any threshold value. If me-too drugs are required to be least as efficient as the comparators, olanzapine would still be cost-effective under 0.031 USD/mg. Aripiprazole was absolutely dominated by risperidone. The sensitivity analysis showed important uncertainty, which was expected. There is, nevertheless, a prominent separation between ziprasidone, quetiapine and the efficiency frontier. Aripiprazole was not considered cost-effective even when its price was set at zero: CER = USD 4,102 vs. USD 3,945 (haloperidol), USD 3,616 (chlorpromazine), USD 3,646 (risperidone) and USD 3,752 (olanzapine) USD/QALY.

Conclusion: Olanzapine was considered the most cost-effective drug for the first-line treatment of schizophrenia in Brazil. Aripiprazole was dominated by risperidone and was not considered cost-effective against olanzapine.

Implications for health care provision and use: This work demonstrated, using a price adjustment process, that there is no viable price that would make aripiprazole cost-effective for incorporation in the Brazilian public health system in the first-line of treatment of schizophrenia. The drug can be useful in specific cases, since individual variability of response to antipsychotic drugs is important.

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来源期刊
CiteScore
2.20
自引率
6.20%
发文量
8
期刊介绍: The Journal of Mental Health Policy and Economics publishes high quality empirical, analytical and methodologic papers focusing on the application of health and economic research and policy analysis in mental health. It offers an international forum to enable the different participants in mental health policy and economics - psychiatrists involved in research and care and other mental health workers, health services researchers, health economists, policy makers, public and private health providers, advocacy groups, and the pharmaceutical industry - to share common information in a common language.
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