Cost-utility Analysis Of Medication Regimens For Tic Disorders In Children And Adolescents Based On Scales Mapping Methods

Objective: Tic disorder is a neuropsychiatric disorder,that has a negative impact on the quality of life in children and adolescents.Clinical pharmacological approaches were the most common therapy,it is vital for us to evaluate the rationality of its clinical medication.Therefore,the first aim of this study is to perform a systematic review to analyze the effectiveness and safety of drugs in the treatment of tic disorder.Second,mapping the Yale Global Tic Severity Scale(YGTSS)onto the Euro Qol five-dimension questionnaire youth version three levels(EQ-5D-Y-3L)in patients with Tic disorder.Finally,to evaluate the economics of risperidone and aripiprazole in the treatment of children and adolescents with tic disorder.Methods: Firstly,we conducted a systematic search for randomized controlled trials or randomized crossover controlled trials on medications employed as therapy in Tic disorder,and a network meta-analysis was performed to compare their relative efficacy and safety.Secondly,General linear models,Beta regression model and principal component regression model were used to modeling.Finally,a Markov model simulating a cohort of patients with tic disorder using risperidone or aripiprazole as therapy was constructed from a payer perspective over one year to evaluate their relative cost-utility.Results: 1.The results of the network meta-analysis show that the drugs ranked first in the order of pros and cons of each outcomes are as follows: YGTSS total tic score: sodium valproate(The Surface Under the Cumulative RAnking curve,SUCRA= 3.2%);YGTSS motor tics: topiramate(SUCRA = 19.5%);YGTSS vocal tics:topiramate(SUCRA = 14.0%);YGTSS tics related impairment: topiramate(SUCRA= 0.0%);YGTSS global score: topiramate(SUCRA = 2.6 %);Response rate:desipramine(SUCRA = 97.2%);the incidence of adverse reactions: risperidone(SUCRA = 12.0%).2.Using two methods and four models to map YGTSS onto EQ-5D-Y,the average utility value predicted by the model is higher than the measured value;the principal component regression model is used to construct each item of three scales.For the mapping function of the main effect,the predicted mean value of the utility value is lower than the measured value.3.The basic analysis results of cost-utility analysis show that the cost of risperidone is ￥2570.74 lower than the cost of aripiprazole,and the quality-adjusted life-year obtained is 0.00064 years less,and the incremental cost-effective ratio(ICER)is ￥4004394.28/year.Conclusion:1.The network meta-analysis results suggest that sodium valproate and topiramate have advantages in reducing YGTSS tics and tics related impairment,respectively,while desipramine and risperidone have advantages in response rate and the incidence of adverse reactions,respectively.2.Mapping YGTSS onto EQ-5D-Y by a variety of models.The results show that the predictive ability of each model is equivalent and relatively well,which can be used for subsequent cost-utility analysis.3.The results of basic analysis suggest that risperidone tablets are more likely to have a cost-utility ratio compared with aripiprazole in the treatment of children and adolescents with tic disorders.