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Systematic review of the methods of health economic models assessing antipsychotic medication for schizophrenia. PLoS One 2020; 15:e0234996. [PMID: 32649663 PMCID: PMC7351140 DOI: 10.1371/journal.pone.0234996] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 06/05/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Numerous economic models have assessed the cost-effectiveness of antipsychotic medications in schizophrenia. It is important to understand what key impacts of antipsychotic medications were considered in the existing models and limitations of existing models in order to inform the development of future models. OBJECTIVES This systematic review aims to identify which clinical benefits, clinical harms, costs and cost savings of antipsychotic medication have been considered by existing models, to assess quality of existing models and to suggest good practice recommendations for future economic models of antipsychotic medications. METHODS An electronic search was performed on multiple databases (MEDLINE, EMBASE, PsycInfo, Cochrane database of systematic reviews, The NHS Economic Evaluation Database and Health Technology Assessment database) to identify economic models of schizophrenia published between 2005-2020. Two independent reviewers selected studies for inclusion. Study quality was assessed using the National Institute for Health and Care Excellence (NICE) checklist and the Cooper hierarchy. Key impacts of antipsychotic medications considered by exiting models were descriptively summarised. RESULTS Sixty models were included. Existing models varied greatly in key impacts of antipsychotic medication included in the model, especially in clinical outcomes used for assessing reduction in psychotic symptoms and types of adverse events considered in the model. Quality of existing models was generally low due to failure to capture the health and cost impact of adverse events of antipsychotic medications and input data not obtained from best available source. Good practices for modelling antipsychotic medications are suggested. DISCUSSIONS This review highlights inconsistency in key impacts considered by different models, and limitations of the existing models. Recommendations on future research are provided.
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Jin H, Tappenden P, Robinson S, Achilla E, MacCabe JH, Aceituno D, Byford S. A Systematic Review of Economic Models Across the Entire Schizophrenia Pathway. PHARMACOECONOMICS 2020; 38:537-555. [PMID: 32144726 DOI: 10.1007/s40273-020-00895-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Schizophrenia is associated with a high economic burden. Economic models can help to inform resource allocation decisions to maximise benefits to patients. OBJECTIVES This systematic review aims to assess the availability, quality and consistency of conclusions of health economic models evaluating the cost effectiveness of interventions for schizophrenia. METHODS An electronic search was performed on multiple databases (MEDLINE, EMBASE, PsycINFO, Cochrane database of systematic reviews, NHS Economic Evaluation Database and Health Technology Assessment database) to identify economic models of interventions for schizophrenia published between 2005 and 2020. Two independent reviewers selected studies for inclusion. Study quality was assessed using the National Institute for Health and Care Excellence (NICE) checklist and the Cooper hierarchy. Model characteristics and conclusions were descriptively summarised. RESULTS Seventy-three models met inclusion criteria. Seventy-eight percent of existing models assessed antipsychotics; however, due to inconsistent conclusions reported by different studies, no antipsychotic can be considered clearly cost effective compared with the others. A very limited number of models suggest that the following non-pharmacological interventions might be cost effective: psychosocial interventions, stratified tests, employment intervention and intensive intervention to improve liaison between primary and secondary care. The quality of included models is generally low due to use of a short time horizon, omission of adverse events of interventions, poor data quality and potential conflicts of interest. CONCLUSIONS This review highlights a lack of models for non-pharmacological interventions, and limitations of the existing models, including low quality and inconsistency in conclusions. Recommendations on future modelling approaches for schizophrenia are provided.
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Affiliation(s)
- Huajie Jin
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Box 024, The David Goldberg Centre, London, SE5 8AF, UK.
| | - Paul Tappenden
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Stewart Robinson
- School of Business and Economics, Loughborough University, Epinal Way, Loughborough, Leicestershire, LE11 3TU, UK
| | | | - James H MacCabe
- Department of Psychosis Studies, PO63, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - David Aceituno
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Box 024, The David Goldberg Centre, London, SE5 8AF, UK
| | - Sarah Byford
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Box 024, The David Goldberg Centre, London, SE5 8AF, UK
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Zhou J, Millier A, François C, Aballéa S, Toumi M. Systematic review of utility values used in the pharmacoeconomic evaluations for schizophrenia: implications on cost-effectiveness results. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2019; 7:1648973. [PMID: 31489150 PMCID: PMC6713214 DOI: 10.1080/20016689.2019.1648973] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/18/2019] [Accepted: 07/22/2019] [Indexed: 06/10/2023]
Abstract
Background and Objectives: Utility elicitation studies for schizophrenia generate different utility values for the same health states. We reviewed utility values used in schizophrenia pharmacoeconomic evaluations and evaluated the impact of their selection on the incremental cost-effectiveness ratio (ICER). Methods: A systematic search was performed in Medline and Embase. Health state definitions, associated utility values, elicitation studies, and value selection processes were extracted. Sets of utility values for all schizophrenia health states were used in a cost-effectiveness model to evaluate the ICER. Results: Thirty-five cost-utility analyses (CUAs) referring to 11 utility elicitation studies were included. The most frequent health states were 'stable' (28 CUAs, 7 utility elicitation studies, 10 values, value range 0.650-0.919), 'relapse requiring hospitalisation' (18, 5, 7, 0.270-0.604), 'relapse not requiring hospitalisation' (18, 5, 10, 0.460-0.762), and 'relapse only' (10, 5, 6, 0.498-0.700). Seventeen sets of utility values were identified with difference in utility values between relapse and stable ranging from -0.358 to -0.050, resulting in ICERs ranging from -56.2% to +222.6% from average. Conclusion: The use of utility values for schizophrenia health states differs among CUAs and impacts on the ICER. More rigorous and transparent use of utility values and sensitivity analysis with different sets of utility values are suggested for future CUAs.
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Affiliation(s)
- Junwen Zhou
- Public Health Department, Aix-Marseille University, Marseille, France
| | - Aurélie Millier
- Health Economic and Outcome Research Department, Creativ-Ceutical, Paris, France
| | - Clément François
- Public Health Department, Aix-Marseille University, Marseille, France
- Health Economic and Outcome Research Department, Creativ-Ceutical, Paris, France
| | - Samuel Aballéa
- Health Economic and Outcome Research Department, Creativ-Ceutical, Rotterdam, Netherlands
| | - Mondher Toumi
- Public Health Department, Aix-Marseille University, Marseille, France
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Zhou J, Millier A, Toumi M. Systematic review of pharmacoeconomic models for schizophrenia. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2018; 6:1508272. [PMID: 30128087 PMCID: PMC6095033 DOI: 10.1080/20016689.2018.1508272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/24/2018] [Accepted: 07/26/2018] [Indexed: 06/08/2023]
Abstract
Background: Economic models are broadly used in the economic evaluation of antipsychotics in schizophrenia. Our objective was to summarize the structure of these models. Methods: Model-based economic evaluations of antipsychotics in schizophrenia were identified through Medline and Embase. General information was extracted including analysis type, model type, perspective, population, comparator, outcome, and timeframe. Model-specific structures for decision tree (DT), cohort- and patient-level Markov model (CLMM, PLMM), and discrete-event simulation (DES) models were extracted. Results: A screen of 1870 records identified 79 studies. These were mostly cost-utility analyses (n = 48) with CLMM (n = 32) or DT models (n = 29). They mostly applied payer perspective (n = 68), focused on general schizophrenia for relapse prevention (n = 73), compared pharmacotherapies as first-line (n = 71), and evaluated incremental cost per quality-adjusted life year (QALY) gained (n = 40) with a 1-year (n = 32) or 5-year (n = 26) projection. DT models progressed with the branching points of response, relapse, discontinuation, and adherence. CLMM models transitioned between disease states, whereas PLMM models transitioned between adverse event states with/without disease state. DES models moved forward with times to remission, relapse, psychiatrist visit, and death. Conclusions: A pattern of pharmacoeconomic models for schizophrenia was identified. More subtle structures and patient-level models are suggested for a future modelling exercise.
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Affiliation(s)
- Junwen Zhou
- Public Health Department, Aix-Marseille University, Marseille, France
| | - Aurélie Millier
- Health Economics and Outcomes Research Department, Creativ-Ceutical, Paris, France
| | - Mondher Toumi
- Public Health Department, Aix-Marseille University, Marseille, France
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Sonntag M, König HH, Konnopka A. The estimation of utility weights in cost-utility analysis for mental disorders: a systematic review. PHARMACOECONOMICS 2013; 31:1131-54. [PMID: 24293216 DOI: 10.1007/s40273-013-0107-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To systematically review approaches and instruments used to derive utility weights in cost-utility analyses (CUAs) within the field of mental disorders and to identify factors that may have influenced the choice of the approach. METHODS We searched the databases DARE (Database of Abstracts of Reviews of Effects), NHS EED (National Health Service Economic Evaluation Database), HTA (Health Technology Assessment), and PubMed for CUAs. Studies were included if they were full economic evaluations and reported quality-adjusted life-years as the health outcome. Study characteristics and instruments used to estimate utility weights were described and a logistic regression analysis was conducted to identify factors associated with the choice of either the direct (e.g. standard gamble) or the preference-based measure (PBM) approach (e.g. EQ-5D). RESULTS We identified 227 CUAs with a maximum in 2009, 2010, and 2012. Most CUAs were conducted in depression, dementia, or psychosis, and came from the US or the UK, with the EQ-5D being the most frequently used instrument. The application of the direct approach was significantly associated with depression, psychosis, and model-based studies. The PBM approach was more likely to be used in recent studies, dementia, Europe, and empirical studies. Utility weights used in model-based studies were derived from only a small number of studies. LIMITATIONS We only searched four databases and did not evaluate the quality of the included studies. CONCLUSIONS Direct instruments and PBMs are used to elicit utility weights in CUAs with different frequencies regarding study type, mental disorder, and country.
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Affiliation(s)
- Michael Sonntag
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany,
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Boncz I, Kaló Z, Mohamed Ibrahim MIB, Greenberg D. Further Steps in the Development of Pharmacoeconomics, Outcomes Research, and Health Technology Assessment in Central and Eastern Europe, Western Asia, and Africa. Value Health Reg Issues 2013; 2:169-170. [DOI: 10.1016/j.vhri.2013.07.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Liu C, Wang H, Xing X, Xu Y, Ma JA, Zhang B. Selective C4–F bond cleavage of pentafluorobenzene: synthesis of N-tetrafluoroarylated heterocyclic compounds. Tetrahedron Lett 2013. [DOI: 10.1016/j.tetlet.2013.06.055] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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