TY - JOUR

T1 - Kosteneffektivität von Quetiapin und Haloperidol bei Patienten mit partiell therapieresistenter Schizophrenie

AU - Braun, Sebastian

AU - Zeidler, Jan

AU - Mittendorf, Thomas

AU - Von Der Schulenburg, J. Matthias Graf

PY - 2010/7

Y1 - 2010/7

N2 - Background: Schizophrenia entails a high cost burden to payers in many healthcare systems across the world. In Germany, direct costs of schizophrenia and other delusional disorders came to € 2.7 billion within the statutory healthcare system in 2006. The resulting direct costs can be especially high in patients who only experience a partial response to conventional antipsychotic treatment. Methods: A cost-effectiveness analysis of quetiapine vs. haloperidol was conducted based on an adaptation of an international health economic Markov model. The model takes the perspective of the German Statutory Health Insurance with a base case time horizon of five years incorporating a cycle length of three months. A patient may transition between eleven distinct health states. The initial distribution to different health states and the transition probabilities between them over time are taken from a randomised controlled trial supported by additional data from the literature. Official German remuneration prices were used for drugs, including outpatient as well as inpatient services. Cost and health outcomes were calculated as incremental cost per relapse avoided and alternatively as incremental cost per additional year under response to treatment. The results were thoroughly tested in several sensitivity analyses. Results: Mean costs per patient are € 49,097 for quetiapine and € 48,899 for patients treated with haloperidol for the whole 5-year period. As expected, costs for medication are considerably higher for quetiapine (€ 7,204) compared to haloperidol (€ 205). However, substantial cost offsets are achieved by a reduction in the utilization of other healthcare services which nearly compensate the higher medication costs. Over the duration of the model, patients with quetiapine on average have 0.18 fewer relapses and respond to medication for an extra 0.32 years. Thus, costs per avoided relapse (additional year under response) are € 1,096 (€ 616), respectively. The results were robust to alterations of key assumptions in the sensitivity analyses. Only a variation of efficacy between quetiapine and haloperidol by 50% as observed in the clinical trial, and a variation of the share of hospitalized patients after relapse lead to a significant impact on the overall results of the model. Conclusions: The results of the evaluation suggest that quetiapine may represent a cost-effective intervention for the clinically relevant group of partial responders in the context of the German Statutory Health Insurance.

AB - Background: Schizophrenia entails a high cost burden to payers in many healthcare systems across the world. In Germany, direct costs of schizophrenia and other delusional disorders came to € 2.7 billion within the statutory healthcare system in 2006. The resulting direct costs can be especially high in patients who only experience a partial response to conventional antipsychotic treatment. Methods: A cost-effectiveness analysis of quetiapine vs. haloperidol was conducted based on an adaptation of an international health economic Markov model. The model takes the perspective of the German Statutory Health Insurance with a base case time horizon of five years incorporating a cycle length of three months. A patient may transition between eleven distinct health states. The initial distribution to different health states and the transition probabilities between them over time are taken from a randomised controlled trial supported by additional data from the literature. Official German remuneration prices were used for drugs, including outpatient as well as inpatient services. Cost and health outcomes were calculated as incremental cost per relapse avoided and alternatively as incremental cost per additional year under response to treatment. The results were thoroughly tested in several sensitivity analyses. Results: Mean costs per patient are € 49,097 for quetiapine and € 48,899 for patients treated with haloperidol for the whole 5-year period. As expected, costs for medication are considerably higher for quetiapine (€ 7,204) compared to haloperidol (€ 205). However, substantial cost offsets are achieved by a reduction in the utilization of other healthcare services which nearly compensate the higher medication costs. Over the duration of the model, patients with quetiapine on average have 0.18 fewer relapses and respond to medication for an extra 0.32 years. Thus, costs per avoided relapse (additional year under response) are € 1,096 (€ 616), respectively. The results were robust to alterations of key assumptions in the sensitivity analyses. Only a variation of efficacy between quetiapine and haloperidol by 50% as observed in the clinical trial, and a variation of the share of hospitalized patients after relapse lead to a significant impact on the overall results of the model. Conclusions: The results of the evaluation suggest that quetiapine may represent a cost-effective intervention for the clinically relevant group of partial responders in the context of the German Statutory Health Insurance.

UR - http://www.scopus.com/inward/record.url?scp=79958032929&partnerID=8YFLogxK

U2 - 10.1007/BF03320763

DO - 10.1007/BF03320763

M3 - Article

AN - SCOPUS:79958032929

VL - 8

SP - 21

EP - 29

JO - PharmacoEconomics - German Research Articles

JF - PharmacoEconomics - German Research Articles

SN - 1612-3727

IS - 1

ER -