Secondgeneration Antipsychotics Costeffectiveness, Policy二代抗精神病药物的成本效益、政策.pptVIP

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Secondgeneration Antipsychotics Costeffectiveness, Policy二代抗精神病药物的成本效益、政策.ppt

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Secondgeneration Antipsychotics Costeffectiveness, Policy二代抗精神病药物的成本效益、政策

De-diffusion of medical treatments: Atypical antipsychotics the treatment of mental illness Robert Rosenheck MD Yale Medical School Global Antipsychotic Market Achieved $10.2B In Sales in 2003 Primary Questions Addressed by CATIE Schizophrenia Trial CATIE Schizophrenia Trial Design Primary Outcome Measure:All-Cause Treatment Discontinuation Treatment-Emergent Adverse Events Treatment-Emergent Neurologic Effects Weight change from Baseline to Last Observation CATIE Cost Effectiveness Analysis (CEA) Study Design Comparison of Initiation Strategies (Intent-to-Treat including all follow-up data) Comparison of “fail first” strategies with different starting agents. Secondary analysis “on initially assigned treatment” excluded observations after first medication change (as in NEJM paper). CATIE multi-phase algorithm assured balanced treatment after first discontinuation. 98% received atypicals Balance across atypicals. CATIE Cost-Effectiveness (2) EFFECTIVENESS Methods: Measuring Effectiveness 1) PANSS Total Score: “Gold standard” for symptom comparison: paired comparisons between groups. 2) Primary Outcome Measure: Health State Utility Assessment in Quality Adjusted Life Years [QALYs]: following Gold, 1996. Measurement is based on the PANSS-based health states and measures of side effects using methods developed by Lenert et al. 2004 (societal preferences); 3) An aggregate health status measure weighted by patient importance ratings (patient preferences); 4) Visual Analogue Scale: subjective patient global rating of overall health from 0 (worst possible health) to 100 (perfect health) 5) Lehman QOL question (How would you rate your life overall (1-7, delighted to terrible). CATIE Cost-Effectiveness Results (1) COST Service Use and Cost Measures Service Use (Service Use and Resources Form [SURF]) Outpatient Mental health Medical Inpatient Mental Health Substance Abuse Medical Nursing home Residential Medication records Criminal justice, public support, productivity