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首页> 外文期刊>P & T: a peer-reviewed journal for formulary management >Cardiometabolic Consequences of Therapy For Chronic Schizophrenia Using Second-Generation Antipsychotic Agents in a Medicaid Population Clinical and Economic Evaluation
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Cardiometabolic Consequences of Therapy For Chronic Schizophrenia Using Second-Generation Antipsychotic Agents in a Medicaid Population Clinical and Economic Evaluation

机译：在医疗补助人群中使用第二代抗精神病药治疗慢性精神分裂症的心律失常后果临床和经济评估

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ABSTRACT Objective: We assessed the potential clinical and economic impact of coronary heart disease (CHD) and diabetes arising after the use of second-generation ("atypical") antipsychotic agents for the treatment of chronic schizophrenia. We compared the use of these medications in patients with a higher risk of cardiometabolic adverse events (in a higher-risk scenario) and in patients with a lower risk (in a lower-risk scenario). Our U.S.-based analysis estimated the costs of CHD and diabetes arising from antipsychotic medication-related cardiometabolic effects. Methods: We constructed a health economic model to predict the 5-year incidence of CHD and diabetes and associated costs after treatment. In this cost-consequence model, we used CHD risk functions derived from the Framingham Heart Study and diabetes risk functions derived from the Atherosclerosis Risk in Communities (ARIC) study. Patient characteristics and treatment effects on cardiometabolic risk factors were estimated from the Clinical Trials of Antipsychotic Treatment Effectiveness (CATIE) study. We evaluated two cost-consequence scenarios: the incidence of CHD and diabetes predicted for 1,000 patients with chronic schizophrenia in a higher-risk scenario based on data from CATIE associated with olanzapine (Zyprexa) and in a lower-risk scenario with ziprasidone (Geodon). We evaluated rates of adverse outcomes for each scenario and the cost of treatment for CHD and diabetes. All costs were reported in 2011 U.S. dollars. Because Medicaid is often the payer for patients with chronic schizophrenia, all costs in this analysis were derived from the perspective of Medicaid. Results: Over a period of 5 years in 1,000 patients with chronic schizophrenia, the higher-risk scenario with olanzapine showed a 9% increased incidence of CHD and a 59% increased incidence of diabetes, compared with no change in treatment from baseline. By contrast, the lower-risk scenario with ziprasidone showed a 9% reduced incidence of CHD and a 10% reduced incidence of diabetes. The higher-risk scenario led to increased CHD-related costs of $83,206 and to increased diabetes-related costs of $456,399. Conclusion: Our study underscores the importance of monitoring the established risk factors for CHD and diabetes in patients using second-generation antipsychotic drugs. Lower-risk agents from this class may lead to substantially decreased costs in the management of CHD and diabetes when compared with higher-risk agents.
机译：摘要目的：我们评估了使用第二代（“非典型”）抗精神病药治疗慢性精神分裂症后冠心病（CHD）和糖尿病的潜在临床和经济影响。我们比较了在心血管代谢不良事件风险较高（较高风险的情况下）和风险较低的患者（较低风险的情况下）使用这些药物的情况。我们在美国的分析估算了由抗精神病药物相关的心脏代谢作用引起的冠心病和糖尿病的费用。方法：我们构建了一个健康经济模型，以预测冠心病和糖尿病的5年发病率以及治疗后的相关费用。在此成本后果模型中，我们使用了源自Framingham心脏研究的CHD风险函数和源自社区动脉粥样硬化风险（ARIC）研究的糖尿病风险函数。根据抗精神病药物治疗效果的临床试验（CATIE）研究估计了患者特征和对心血管代谢危险因素的治疗效果。我们评估了两种成本后果方案：根据与奥氮平（Zyprexa）相关的CATIE数据和在与齐拉西酮（Geodon）相关的较低风险方案中，在较高风险方案中预测的1,000例慢性精神分裂症患者的冠心病和糖尿病发生率。我们评估了每种情况下的不良结局发生率以及冠心病和糖尿病的治疗费用。所有费用均以2011年美元为单位报告。由于Medicaid通常是慢性精神分裂症患者的付款人，因此本分析中的所有费用均来自Medicaid的观点。结果：在5年的时间里，对1000例慢性精神分裂症患者而言，奥氮平的高危情况显示CHD发生率增加9％，糖尿病发生率增加59％，而基线治疗无变化。相比之下，齐拉西酮的低危病例显示冠心病的发生率降低了9％，糖尿病的发生率降低了10％。高风险情景导致冠心病相关费用增加83,206美元，糖尿病相关费用增加456,399美元。结论：我们的研究强调了使用第二代抗精神病药物监测已确定的冠心病和糖尿病危险因素的重要性。与高风险药物相比，此类风险较低的药物可能会导致冠心病和糖尿病的治疗费用大大降低。

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