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A simulation model to estimate 10-year risk of coronary heart disease events in patients with schizophrenia spectrum disorders treated with second-generation antipsychotic drugs

Josep  Darbà, PhD

Department of Economics, University of Barcelona, Barcelona, Spain

Lisette  Kaskens, MSc

BCN Health Economics & Outcomes Research, Barcelona, Spain

Pedro  Aranda, MD

Hypertension and Cardiovascular Unit, Carlos Haya Hospital, Málaga, Spain

Celso  Arango, MD

Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain

Julio  Bobes, MD

CIBERSAM, Madrid, Spain , Medicine Department, Psychiatry Area, University of Oviedo, Oviedo (Asturias), Spain

Rafael  Carmena, MD

Department of Endocrinology, Valencia University Clinic Hospital, Valencia, Spain

Javier  Rejas, MD

Health Outcomes Research Department, Medical Unit, Pfizer España, Alcobendas (Madrid), Spain

BACKGROUND: The risk for cardiovascular (CV) events has been shown to be considerably higher among schizophrenia patients than the general population.

OBJECTIVE: The aim of this study was to describe a general stochastic simulation model for the treatment of schizophrenia related to CV-associated risks of second-generation antipsychotics (SGAs).

METHODS: A model to simulate the expected 10-year incidence of all types of coronary heart disease (CHD) events in patients treated with SGAs was developed from the Cardiovascular, Lipid and Metabolic Outcomes Research in Schizophrenia (CLAMORS) study to reproduce baseline conditions, The CHD event risk was estimated through a locally adjusted Framingham risk function using the expected mean change in the CV risk factors from the Clinical Antipsychotic Trials in Intervention Effectiveness (CATIE) study.

RESULTS: The 10-year CHD event rate after treatment with SGAs was 0.181, 0.179, 0.176, and 0.172 for olanzapine, quetiapine, risperidone, and ziprasidone, respectively. Relative risk was calculated relative to no treatment, and values were as follows: olanzapine, 1.03 ± 1.05 (95% CI, 0.74 to 1.42), quetiapine, 1.02 ± 1.05 (95% CI, 0.74 to 1.41), risperidone, 1.00 ± 0.99 (95% CI, 0.73 to 1.36), and ziprasidone, 0.97 ± 0.95 (95% CI, 0.72 to 1.31). There were approximately 25,269 CHD events over a 10-year period in schizophrenia patients treated with olanzapine, 25,157 events with quetiapine, 24,883 with risperidone, and 24,514 events with ziprasidone.

CONCLUSIONS: The estimated outcomes suggest that each SGA shows a different level of CV event risk, with ziprasidone showing the lowest rate without any association for increased risk of CHD.

KEYWORDS: cardiovascular events, coronary heart disease, Framingham function, modeling schizophrenia, second-generation antipsychotics


CORRESPONDENCE: Josep Darbà, PhD, Department of Economics, University of Barcelona, Diagonal 690, 08034 Barcelona, Spain E-MAIL: darba@ub.edu
Annals of Clinical Psychiatry ©2013 Quadrant HealthCom Inc.

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