OBJECTIVES: To estimate the cost-effectiveness of different treatment strategies for schizophrenia and to provide evidence for clinical decision-making in China.

METHODS: A Markov model with three health states (stable, relapse, and dead) was developed to simulate the progression of a cohort of patients with schizophrenia, considering the patient compliance. From the healthcare system perspective, the medication costs and inpatient costs were collected. The cumulative costs (in Chinese Yuan, CNY) and health outcomes (in Quality-Adjusted Life Year, QALY) over 5 years were estimated for the treatment strategies with daily oral administration, as well as one injection every half, one, three, and six months. The incremental cost-effectiveness ratios (ICERs) were calculated for the comparisons of different strategies for treating schizophrenia. The robustness of results was assessed by sensitivity analyses.

RESULTS: The 5-year treatment costs predicted by model of daily oral administration and one injection every half, one, three and six months were 139,043.2 CNY, 210,526.6 CNY, 179,465.6 CNY, 158,927.8 CNY, and 525,050.7 CNY. The quality-adjusted survivals of five treatment strategies above were 4.10 QALYs, 4.19 QALYs, 4.34 QALYs, 4.33 QALYs, and 4.26 QALYs, respectively. Daily oral administration strategy was least costly, while every-1-month injection strategy was most effective. The strategies of giving one injection every half month and every six months were more costly and less effective than every-1-month injection strategy. The costs per QALY gained were 85,614.6 CNY for every-3-month injection strategy and 4,078,215.6 CNY for every-1-month injection strategy, compared with the daily oral medication. Sensitivity analyses suggested the good reliability of model outcomes.

CONCLUSIONS: With the threshold of three times per capita Gross Domestic Product (242,928 CNY) in 2021 in China, the treatment strategy of giving one injection every three months is cost-effective, which might provide evidence for making treatment choice for schizophrenia in China.