Pharmacoeconomics of atypical antipsychotics induced metabolic syndrome: a critical evaluation of cost implications and health outcomes

Abstract

Objectives: Global risk of atypical antipsychotics (ATPs) induced metabolic syndrome (MS) is high with increasing prescription rates. Metabolic monitoring systems reduces the burden of MS, however, is poorly performed in clinical setting. The objective of this study was to critically assesses the cost implications of ATPs induced MS and metabolic monitoring. Methods: Primary studies on cost analysis of ATPs induced MS were assessed based on consolidated health economic evaluation reporting standards (CHEERS). Inclusion criteria were: cost analysis of ATPs induced MS and cost of metabolic monitoring of ATPs vs. no ATPs/MS, published from 2000-April 2018. Economic models expressed in cost per quality-adjusted life year (QALY) were analysed. MEDLINE, EMBASE, CENTRAL databases and cost-effectiveness analysis registry were searched. Primary outcomes were (i) Reporting standards; (ii) Technical merits and (iii) applicability to local decision making with diverse perspectives. Results: Three studies were included which modelled 16,371 cohorts (including a simulated hypothetical cohort of 10,000 patients) from healthcare provider, payer and societal perspectives. One study complied with the CHEERS statement whereas the other two demonstrated partial pharmacoeconomics evaluation. ATPs induced MS incurred significantly higher total care costs compared with those without these conditions (F=710.08; p<0.0001) or those not treated with ATPs (F=2855.54; p<0.0001). Burden of MS was higher among youth. Ziprasidone appeared cost effective as compared to olanzapine and quetiapine in the management of schizophrenia. Ziprasidone also led to marginally higher QALYs when compared with risperidone, however, was costlier (each QALY gained costs an additional $218 060). None of the studies assessed the cost effectiveness of metabolic monitoring systems. Conclusions: ATPs induced MS is associated with significantly higher healthcare services costs. Burden of illness is higher among youth as compared to adults. Risperidone and Ziprasidone appears cost effective with QALY gained. Lack of cost effectiveness studies of metabolic monitoring systems demonstrates technical inefficiency.L20014033202018-12-28 <br />