{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T10:58:28Z","timestamp":1788519508024,"version":"build-2803163510"},"reference-count":40,"publisher":"Royal College of Psychiatrists","issue":"2","license":[{"start":{"date-parts":[[2024,12,26]],"date-time":"2024-12-26T00:00:00Z","timestamp":1735171200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Br J Psychiatry"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec id=\"S0007125024002514_sec_a1\"><jats:title>Background<\/jats:title><jats:p>Previous economic evidence about interventions for schizophrenia is outdated, non-transparent and\/or limited to a specific clinical context.<\/jats:p><\/jats:sec><jats:sec id=\"S0007125024002514_sec_a2\"><jats:title>Aims<\/jats:title><jats:p>We developed a <jats:italic>de novo<\/jats:italic> discrete event simulation (DES) model for estimating the cost-effectiveness of interventions in schizophrenia in the UK.<\/jats:p><\/jats:sec><jats:sec id=\"S0007125024002514_sec_a3\" sec-type=\"methods\"><jats:title>Method<\/jats:title><jats:p>The DES model was developed based on the structure of previous models, populated with demographic, clinical and cost data from the UK, and antipsychotics' effects from recent network meta-analyses. We simulated treatment pathways for patients with first-episode schizophrenia including events such as relapse, remission, treatment discontinuation, cardiovascular disease and death and estimated costs (2020\u00a3) taking the National Health Service perspective and quality-adjusted life years (QALYs) over ten years. Using the model, we ranked ten first-line antipsychotics based on their QALYs and cost-effectiveness.<\/jats:p><\/jats:sec><jats:sec id=\"S0007125024002514_sec_a4\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>Amisulpride was associated with the highest QALYs, followed by risperidone long-acting injection (LAI), aripiprazole-LAI (6.121, 6.084, 6.070, respectively) and others (5.947\u20136.058). The most cost-effective antipsychotics were amisulpride, olanzapine and risperidone-LAI, with total probability of rankings of 1, \u22642, \u22643, that is, 95%, 89%, 80%, respectively; meanwhile, the least cost-effective were cariprazine, lurasidone and quetiapine, with total probability of rankings of 10, \u22659, \u22658, that is, 96%, 92%, 81%, respectively. Results were robust across sensitivity analyses and influenced primarily by relapse relevant parameters.<\/jats:p><\/jats:sec><jats:sec id=\"S0007125024002514_sec_a5\" sec-type=\"conclusions\"><jats:title>Conclusions<\/jats:title><jats:p>Our findings suggest amisulpride (or risperidone-LAI where oral treatment is inappropriate) as the best overall first-line option based on QALYs and cost-effectiveness. Our ranking may be used to guide decision-making between antipsychotics. Our model is open source and could be applied to the other settings.<\/jats:p><\/jats:sec>","DOI":"10.1192\/bjp.2024.251","type":"journal-article","created":{"date-parts":[[2024,12,25]],"date-time":"2024-12-25T22:11:22Z","timestamp":1735164682000},"page":"545-552","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":3,"title":["Cost-effectiveness of ten commonly used antipsychotics in first-episode schizophrenia in the UK: economic evaluation based on a <i>de novo<\/i> discrete event simulation model"],"prefix":"10.1192","volume":"227","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6812-0944","authenticated-orcid":false,"given":"Junwen","family":"Zhou","sequence":"first","affiliation":[{"name":"Aix Marseille University"},{"name":"University of Oxford"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aurelie","family":"Millier","sequence":"additional","affiliation":[{"name":"Clever-Access"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Aballea","sequence":"additional","affiliation":[{"name":"Aix Marseille University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clement","family":"Francois","sequence":"additional","affiliation":[{"name":"Aix Marseille University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3872-3998","authenticated-orcid":false,"given":"Huajin","family":"Jin","sequence":"additional","affiliation":[{"name":"Psychology & Neuroscience at King's College London"},{"name":"Peking University"},{"name":"University College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8486-4903","authenticated-orcid":false,"given":"Ryan","family":"Williams","sequence":"additional","affiliation":[{"name":"Imperial College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4972-8786","authenticated-orcid":false,"given":"Belinda","family":"Lennox","sequence":"additional","affiliation":[{"name":"University of Oxford"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4662-8915","authenticated-orcid":false,"given":"Apostolos","family":"Tsiachristas","sequence":"additional","affiliation":[{"name":"University of Oxford"},{"name":"University of Oxford"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mondher","family":"Toumi","sequence":"additional","affiliation":[{"name":"Aix Marseille University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"170","published-online":{"date-parts":[[2024,12,26]]},"reference":[{"key":"S0007125024002514_ref5","doi-asserted-by":"publisher","DOI":"10.1080\/20016689.2018.1508272"},{"key":"S0007125024002514_ref32","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2003.10.010"},{"key":"S0007125024002514_ref34","volume-title":"Unit Costs of Health and Social Care 2020 \u2013 Community-based Health Care Staff","year":"2020"},{"key":"S0007125024002514_ref39","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2014.2133"},{"key":"S0007125024002514_ref19","unstructured":"19 National Health Service Business Services Authority (NHSBA). 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Doctoral thesis, Public Health Department, Aix Marseille University, 2020 (https:\/\/theses.fr\/2020AIXM0090 [cited 25 Jul 2024])."}],"container-title":["The British Journal of Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0007125024002514","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T08:40:45Z","timestamp":1755247245000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0007125024002514\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,26]]},"references-count":40,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,8]]}},"alternative-id":["S0007125024002514"],"URL":"https:\/\/doi.org\/10.1192\/bjp.2024.251","relation":{},"ISSN":["0007-1250","1472-1465"],"issn-type":[{"value":"0007-1250","type":"print"},{"value":"1472-1465","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,26]]},"assertion":[{"value":"\u00a9 The Author(s), 2024. Published by Cambridge University Press on behalf of Royal College of Psychiatrists","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}