title: Cost-effectiveness of second-generation antipsychotics for the treatment of schizophrenia.
abstract: OBJECTIVE
  To compare the cost-effectiveness of alternate treatment strategies using second-generation antipsychotics (SGAs) for patients with schizophrenia.
  
  
  METHODS
  We developed a Markov model to estimate the costs and quality-adjusted life-years (QALYs) for different sequences of treatments for 40-year-old patients with schizophrenia. We considered first-line treatment with one of the four SGAs: olanzapine (OLZ), risperidone (RSP), quetiapine (QTP), and ziprasidone (ZSD). Patients could switch to another of these antipsychotics as second-line therapy, and only clozapine (CLZ) was allowed as third-line treatment. We derived parameter estimates from the Clinical Antipsychotic Trial of Intervention Effectiveness (CATIE) study and published sources.
  
  
  RESULTS
  The ZSD-QTP strategy (first-line treatment with ZSD, change to QTP if ZSD is discontinued, and switch to CLZ if QTP is discontinued) was most costly while yielding the greatest QALYs, with an incremental cost-effective ratio (ICER) of $542,500 per QALY gained compared with the ZSD-RSP strategy. However, the ZSD-RSP strategy had an ICER of $5,200/QALY gained versus the RSP-ZSD strategy and had the greatest probability of being cost-effective given a willingness-to-pay threshold between $50,000 and $100,000 per QALY. All other treatment strategies were more costly and less effective than another strategy or combination of other strategies. Results varied by different time horizons adopted.
  
  
  CONCLUSIONS
  The ZSD-RSP strategy was most cost-effective at a willingness-to-pay threshold between $5,200 and $542,500 per QALY. Our results should be interpreted with caution because they are based largely on the CATIE trial with potentially limited generalizability to all patient populations and doses of SGAs used in practice.
authors: College of Pharmacy, University of Minnesota, Minneapolis, MN.
authors: Taehwan
authors: T
authors: Park
authors: School of Public Health, University of Minnesota, Minneapolis, MN. Electronic address: kmkuntz@umn.edu.
authors: Karen M
authors: KM
authors: Kuntz
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000191:economics* / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000191:economics / Q000627:therapeutic use; D003024:Clozapine / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003987:Dibenzothiazepines / Q000191:economics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D000077152:Olanzapine; D010879:Piperazines / Q000191:economics / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D000069348:Quetiapine Fumarate; D018967:Risperidone / Q000191:economics / Q000627:therapeutic use; D012559:Schizophrenia / Q000188:drug therapy* / Q000191:economics*; D013844:Thiazoles / Q000191:economics / Q000627:therapeutic use
chemical_list: D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D010879:Piperazines; D013844:Thiazoles; D001569:Benzodiazepines; D000069348:Quetiapine Fumarate; C092292:ziprasidone; D003024:Clozapine; D018967:Risperidone; D000077152:Olanzapine
keywords: CATIE; Markov model; cost-effectiveness; schizophrenia; second-generation antipsychotics