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㆟之藥物經濟評估

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

目的：本研究評估口服paliperidone 相對於其他兩種常見口服第二代抗精神病藥物 olanzapine 及quetiapine 用於治療台灣精神分裂症病患的成本效益。方法：藉由發展急性 與長期治療兩個決策分析模式預測六週與一年的健康狀況和醫療花費。在模式中健康效果的 預測因子包括治療中斷率、反應率及復發率。相關醫療資源的使用，包括追蹤、復發和副作 用亦列入考量。透過系統性的文獻回顧、健保局資料庫分析與匿名專家意見收集經過專家會 議取得共識，以得到最好的模式參數預估。健康效果指標為六週內達到療效的病患數和一年 中病患穩定的天數。本研究亦估計總醫療成本和進行敏感度分析。結果：三種藥物中quetiapine 最不具成本效益。paliperidone 比起olanzapine，在六週急性治療期，其差異成本效 益比(incremental cost-effectiveness ratio, ICER) 為每增加一個達到預期療效的病人需多花 新台幣10,700 元。一年後paliperidone 治療組顯示持續接受治療比例較高且達到更多的穩 定天數。Paliperidone 組的ICER 和olanzapine 相比，為每增加一穩定天數需多花費新台幣 400 元。結論：以paliperidone 治療台灣精神分裂症病人為具有成本效益。

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 oneyear 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.