title: Comparative cost-effectiveness of 11 oral antipsychotics for relapse prevention in schizophrenia within Singapore using effectiveness estimates from a network meta-analysis.
abstract: This study modelled the cost-effectiveness of 11 oral antipsychotics for relapse prevention among patients with remitted schizophrenia in Singapore. A network meta-analysis determined the relative efficacy and tolerability of 11 oral antipsychotics (amisulpride, aripiprazole, chlorpromazine, haloperidol, olanzapine, paliperidone, quetiapine, risperidone, sulpiride, trifluoperazine and ziprasidone). The clinical estimates were applied in a Markov model to estimate lifetime costs and quality-adjusted life-years gained. Quality-of-life data were obtained from published literature. Resource utilization and cost data were retrieved from local hospital databases. The annual direct cost of healthcare services for a patient experiencing a relapse episode was three-fold that of a patient not in relapse of schizophrenia. The most favourable pharmacological treatment for relapse prevention was olanzapine with an annual probability of relapse of 0.24 (0.13-0.38) with placebo as a reference of 0.75 (0.73-0.78). Olanzapine emerged as the dominant treatment with the highest quality-adjusted life-years gained and lowest lifetime costs. Ziprasidone, aripiprazole and paliperidone incurred higher lifetime costs compared with no treatment. Probability and cost of relapse were key drivers of cost-effectiveness in sensitivity analyses. The data can help prescribers in choosing appropriate treatment and payers in allocating resources for the clinical management of this serious psychiatric disorder.
authors.affiliation: aPharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group Departments of bPharmacy cGeneral Psychiatry, Institute of Mental Health, Singapore, Singapore.
authors.forename: Liang
authors.initials: L
authors.lastname: Lin
authors.forename: Ying J
authors.initials: YJ
authors.lastname: Zhao
authors.forename: Hui J
authors.initials: HJ
authors.lastname: Zhou
authors.forename: Ai L
authors.initials: AL
authors.lastname: Khoo
authors.forename: Monica
authors.initials: M
authors.lastname: Teng
authors.forename: Lay B
authors.initials: LB
authors.lastname: Soh
authors.forename: Boon P
authors.initials: BP
authors.lastname: Lim
authors.forename: Kang
authors.initials: K
authors.lastname: Sim
mesh_terms: D000284:Administration, Oral; D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics*; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012008:Recurrence; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D012565:Schizophrenic Psychology; D012846:Singapore; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents