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首页> 外文期刊>ClinicoEconomics and Outcomes Research >Cost-effectiveness model for a hypothetical monotherapy vs standard of care in adult patients with treatment-resistant depression
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Cost-effectiveness model for a hypothetical monotherapy vs standard of care in adult patients with treatment-resistant depression

机译：假设的单药治疗与成年抵抗性抑郁症患者的护理标准的成本效益模型

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Background: Patients with treatment-resistant major depressive disorder (TRD) have limited treatment options. We developed an early stage cost-effectiveness model of TRD to explore the potential value of a hypothetical monotherapy relative to the standard of care (SOC). The relative impacts of the monotherapy’s three differentiating features over SOC are explored: efficacy advantage, tolerability advantage, and price premium. Methods: We adapted an existing economic model of TRD to evaluate the cost-effectiveness of a hypothetical monotherapy for TRD with a 25% efficacy advantage, a 10% tolerability advantage, and a 50% price premium over SOC (selective serotonin reuptake inhibitor plus atypical antipsychotics [SSRI + AAP]). The model is a hybrid of a decision tree that captures patients’ outcomes after an 8-week acute treatment phase and a Markov model that simulates patients’ depression course through a 10-month maintenance phase. Sensitivity (deterministic and probabilistic) and scenario analyses were conducted to characterize the relative impacts of the monotherapy’s three differentiating features over SOC. Results: Over the 12-month time horizon, the hypothetical monotherapy is shown to dominate SOC; it generates lower costs and higher quality-adjusted life years in comparison to SSRI + AAP. Sensitivity and scenario analyses showed that this dominance depends largely on the monotherapy’s efficacy and tolerability advantages over SOC. Specifically, a monotherapy with ≥ 12% efficacy or ≥70% tolerability advantage (and a 50% price premium) will always be superior to SSRI + AAP. Between these two extremes, most profiles, nonetheless, generate incremental cost-utility ratios for the monotherapy, which fall below common payer willingness-to-pay thresholds. Conclusion: Our adaptation of an existing economic model of TRD provides a flexible platform for researchers to evaluate the efficacy/tolerability improvements required for a successful new TRD product and for decision-makers to assess the cost-effectiveness impact of uncertainties inherent in early stage product development in TRD.
机译：背景：患有难治性重度抑郁症（TRD）的患者治疗选择有限。我们开发了TRD的早期成本效益模型，以探索相对于护理标准（SOC）的假设单一疗法的潜在价值。探讨了单一疗法相对于SOC的三个差异特征的相对影响：功效优势，耐受性优势和价格溢价。方法：我们采用了TRD的现有经济模型，以评估假设的TRD单一疗法的成本-效果，与SOC（选择性5-羟色胺再摄取抑制剂加非典型药物）相比，其疗效优势为25％，耐受性优势为10％，价格溢价为50％。抗精神病药[SSRI + AAP]）。该模型是决策树和马尔可夫模型的混合体，决策树可捕获8周的急性治疗阶段后的患者结果，而马尔可夫模型可模拟患者在10个月的维持阶段中的抑郁过程。进行了敏感性（确定性和概率性）和情景分析，以表征单一疗法的三种差异性特征对SOC的相对影响。结果：在12个月的时间范围内，假设的单一疗法被证明在SOC中占主导地位。与SSRI + AAP相比，它产生的成本更低，质量调整后的使用寿命更长。敏感性和情景分析表明，这一优势很大程度上取决于单一疗法相对于SOC的疗效和耐受性优势。具体来说，具有≥12％疗效或≥70％耐受性优势（且价格溢价50％）的单一疗法将始终优于SSRI + AAP。尽管如此，在这两个极端之间，大多数配置文件会为单一疗法产生递增的成本-效用比率，该比率低于常见的付款人支付意愿阈值。结论：我们对TRD现有经济模型的调整为研究人员评估成功的TRD新产品所需的功效/耐受性改善以及决策者评估早期产品固有的不确定性对成本效益的影响提供了灵活的平台开发TRD。

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