Custos e consequências para síndrome metabólica, diabetes e risco de doença coronariana entre pacientes com esquizofrenia tratados com aripiprazol versus olanzapina no Brasil
Custos e consequências para síndrome metabólica, diabetes e risco de doença coronariana entre pacientes com esquizofrenia tratados com aripiprazol versus olanzapina no Brasil
Tipo de documento
Apresentação
Descrição
Resumo apresentado na The Professional Society for Health Economics and Outcomes Research (ISPOR)
Fonte
ISPOR
Ano de publicação
2009
Referência (Vancouver)
Litalien G, Nita M, Golçalves E, Rached R. Costs and consequences for metabolic syndrome, diabetes and coronary heart disease (CHD) risk among schizophrenia patients treated with aripiprazole versus olanzapine in Brazil [Internet]. In: ISPOR Latin America 2009; Rio de Janeiro, Brazil. Disponível em: https\://www\.ispor.org/heor-resources/presentations-database/presentation/ispor-2nd-latin-america-conference/costs-and-consequences-for-metabolic-syndrome-diabetes-and-coronary-heart-disease-chd-risk-among-schizophrenia-patients-treated-with-aripiprazole-versus-olanzapine-in-brazil
Costs and Consequences For Metabolic Syndrome, Diabetes, and Coronary Heart Disease (CHD) Risk Among Schizophrenia Patients Treated with Aripiprazole Versus Olanzapine in Brazil
Document type
Presentation
Description
Abstract presented at The Professional Society for Health Economics and Outcomes Research (ISPOR)
Source
ISPOR
Publication year
2009
Reference (Vancouver)
Litalien G, Nita M, Golçalves E, Rached R. Costs and consequences for metabolic syndrome, diabetes and coronary heart disease (CHD) risk among schizophrenia patients treated with aripiprazole versus olanzapine in Brazil [Internet]. In: ISPOR Latin America 2009; Rio de Janeiro, Brazil. Available from: https\://www\.ispor.org/heor-resources/presentations-database/presentation/ispor-2nd-latin-america-conference/costs-and-consequences-for-metabolic-syndrome-diabetes-and-coronary-heart-disease-chd-risk-among-schizophrenia-patients-treated-with-aripiprazole-versus-olanzapine-in-brazil
Objetivos Os medicamentos antipsicóticos atípicos têm demonstrado aumentar o risco de diabetes e DAC em pacientes, exacerbando os fatores de risco lipídico, de peso e glicêmico que compõem a síndrome metabólica. Estudamos, em uma análise de custo-consequência, os eventos e custos associados ao uso de olanzapina versus aripiprazol a partir de um ensaio clínico randomizado duplo-cego de 16 semanas com pacientes esquizofrênicos. Métodos Um total de 173 pacientes com sobrepeso (índice de massa corporal ≥ 27 kg/m²) com esquizofrenia ou transtorno esquizoafetivo (anteriormente tratados com olanzapina) foram randomizados para tratamento com aripiprazol ou monoterapia continuada com olanzapina por 16 semanas após um período de observação aberto de 2 semanas durante o qual os sujeitos continuaram recebendo olanzapina. A taxa de síndrome metabólica ATP-III e o risco a longo prazo de diabetes e DAC foram estimados e comparados entre os grupos. Custos Brasileiros e estimativas de recursos de saúde foram aplicados a cada evento. Funções de risco estabelecidas foram usadas para estimar o risco de diabetes e DAC. Resultados Entre todos os pacientes, a taxa basal de síndrome metabólica foi de 89%. Em 16 semanas, 80,3% dos pacientes com olanzapina versus 60% dos pacientes com aripiprazol apresentaram síndrome metabólica (RR:0,75; IC95%:0,61-0,92, p=0,006). O risco de diabetes aumentou em 1,3% (pacientes com aripiprazol) e 6,4% (pacientes com olanzapina), diferença de risco = 5,1%. O risco de DAC diminuiu em 0,6% (pacientes com aripiprazol) e aumentou em 0,3% (pacientes com olanzapina), diferença de risco = 0,9%. Entre 1000 pacientes, o tratamento com aripiprazol versus olanzapina evitaria 203 eventos de síndrome metabólica, 51 eventos de diabetes e 9 eventos de DAC a um custo de R$1.520,63, R$1.856, e R$4.122,31 por evento evitado, respectivamente. A diferença total de custo foi de R$440.442. As diferenças de risco foram impulsionadas principalmente por mudanças significativas de peso e lipídios entre os agentes, favorecendo o aripiprazol. Conclusões Eventos adversos metabólicos relacionados a antipsicóticos e o consequente risco de diabetes e DAC podem aumentar substancialmente os custos de saúde entre pacientes com esquizofrenia no Brasil. Os provedores de saúde devem considerar esses riscos na seleção de agentes antipsicóticos apropriados.
Notas
O registro foi originalmente publicado em inglês. A versão em português foi traduzida com o apoio de inteligência artificial.
Abstract
Objetives: Atypical antipsychotic medications have been shown to increase diabetes and CHD risk in patients by exacerbating lipid, weight, and glucose risk factors comprising the metabolic syndrome. We studied in a cost-consequence analysis the events and costs associated with the use of olanzapine versus aripiprazole from a double blind, 16 week randomized trial of schizophrenia patients. Methods A total of 173 overweight patients (body mass index „d 27 kglm2) with schizophrenia or schizoaffective disorder (previously treated with olanzapina) were randomized to treatment with aripiprazole or continued olanzapine monotherapy for 16-weeks following a 2-week, open-label, observation period during which subjects continued to receive olanzapine. The rate of ATP-I Il metabolic syndrome, and the long term risk for diabetes and CHD was estimated and compared between arms. Brazilian costs and health resource estimates were applied to each event. Established risk functions were used to estimate diabetes and CHD risk. Results Among all patients, the baseline rate of metabolic syndrome was 89%. At 16 weeks, 80.3% of olanzapine versus 60% of aripiprazole patients exhibited metabolic syndrome (RR:0.75; 95%Cl:0.61-0.92,p=0.006). Diabetes risk increased by 1.3% (aripiprazole patients) and 6.4% (olanzapine patients), risk difference = 5.1 %. CHD risk decreased by 0.6% (aripiprazole patients) and increased by 0.3% (olanzapine patients), risk difference = 0.9%. Among 1000 patients, treatment with aripiprazole versus olanzapine would avert 203 metabolic syndrome events, 51 diabetes events, and 9 CHD events at a cost of R$1,520.63, R$1.856, and R$4,122.31, per event avoided respectively. The total cost difference was R$440,442. Risk differences were driven primarily by significant weight and lipid changes between agents, favoring aripiprazole. Conclusions Antipsychotic-related metabolic adverse events and the consequent risk of diabetes and CHD can add substantively to health care costs among patients with schizophrenia in Brazil. Health care providers should consider these risks in the selection of appropriate antipsychotic agents.
Notes
The record was originally published in English. The Portuguese version was translated with the aid of artificial intelligence.
