Abstract
BackgroundNumerous 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.ObjectivesThis 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.MethodsAn 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.ResultsSixty 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.DiscussionsThis review highlights inconsistency in key impacts considered by different models, and limitations of the existing models. Recommendations on future research are provided.
Highlights
Antipsychotic medications have been the mainstay of treatment for schizophrenia since the 1950s [1]
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
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
Summary
Antipsychotic medications have been the mainstay of treatment for schizophrenia since the 1950s [1]. They can be used for treating acute psychotic states in the short-term, or preventing relapse in the long-term, either as oral preparations or in the form of long-acting injectable (LAI) preparations. Clinical trials capturing the health and cost outcomes of antipsychotic medications can be complex, time-consuming, and costly. Clinical trials often do not cover all antipsychotic medications of interest, have a short time horizon and use surrogate endpoints or focus only on specific adverse events instead of assessing the entire spectrum of relevant adverse events. 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
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