Pharmacoeconomic Evaluation of Paliperidone Exended Release versus Olanzapine or Quetiapine in the Treatment for Patients with Schizophrenia in Taiwan

Paliperidone持續性藥效錠相對於口服olanzapine或口服quetiapine用於治療台灣精神分裂症病人之藥物經濟評估

10.29478/TJP.201012.0004

蒲若芳(Raoh-Fang Pwu)；劉嘉逸(Chia-Yih Liu)；柯昇穎(Sheng-Ying Ko)；蔡依靜(I-Ching Tsai)；楊延光(Yen-Kuang Yang)

schizophrenia ； second-generation antipsychotics ； cost-effectiveness

台灣精神醫學

24卷4期（2010 / 12 / 01）

280 - 290

英文

Objective: This study is to evaluate the cost-effectiveness of oral paliperidone extended-release (ER) compared to two other commonly prescribed oral second-generation antipsychotics (SGAs), olanzapine and quetiapine, in treating patients with schizophrenia in Taiwan. Methods: We developed two decision analytic models (an acute and a long-term treatment model) to predict six-week and one-year health outcomes as well as total medical expenditure. In those models, we considered medication discontinuation rates, response rates, and relapse rates as well as resource use (frequency and unit costs) of regular follow-up, relapse, and adverse effect management. We did a systematic literature review, analysis of the National Health Insurance Research Database, and collection of experts' opinions to obtain the best estimates for model parameters. Health outcome measures were the number of responding patients at six weeks and the number of stable days per patient during a one-year period. We estimated total direct medical costs, and did sensitivity analyses. Results: Among quetiapine, paliperidone ER, and olanzapine, quetiapine was found in this study to have the highest cost and lowest effectiveness. A higher percentage of patients receiving paliperidone ER was found to respond at the end of the six-week period, with a incremental cost-effectiveness ratio (ICER) of NT$10,700 (per patient who responded) compared with olanzapine (US$1=NT$30.5). After a one-year treatment period, paliperidone ER was found to be associated with a higher proportion of patients continuing initial treatment with more number of stable days. The ICER of paliperidone ER compared to that of olanzapine was NT$400 per stable day. Conclusion: Paliperidone ER is a cost-effective alternative to olanzapine or quetiapine for treating patients with schizophrenia in Taiwan.

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