Cost-effectiveness of pharmacological and psychosocial interventions for schizophrenia

Abstract

BackgroundInformation on cost-effectiveness of interventions to treat schizophrenia can assist health policy decision making, particularly given the lack of health resources in developing countries like Thailand. This study aims to determine the optimal treatment package, including drug and non-drug interventions, for schizophrenia in Thailand.MethodsA Markov model was used to evaluate the cost-effectiveness of typical antipsychotics, generic risperidone, olanzapine, clozapine and family interventions. Health outcomes were measured in disability adjusted life years. We evaluated intervention benefit by estimating a change in disease severity, taking into account potential side effects. Intervention costs included outpatient treatment costs, hospitalization costs as well as time and travel costs of patients and families. Uncertainty was evaluated using Monte Carlo simulation. A sensitivity analysis of the expected range cost of generic risperidone was undertaken.ResultsGeneric risperidone is more cost-effective than typicals if it can be produced for less than 10 baht per 2 mg tablet. Risperidone was the cheapest treatment with higher drug costs offset by lower hospital costs in comparison to typicals. The most cost-effective combination of treatments was a combination of risperidone (dominant intervention). Adding family intervention has an incremental cost-effectiveness ratio of 1,900 baht/DALY with a 100% probability of a result less than a threshold for very cost-effective interventions of one times GDP or 110,000 baht per DALY. Treating the most severe one third of patients with clozapine instead of risperidone had an incremental cost-effectiveness ratio of 320,000 baht/DALY with just over 50% probability of a result below three times GDP per capita.ConclusionsThere are good economic arguments to recommend generic risperidone as first line treatment in combination with family intervention. As the uncertainty interval indicates the addition of clozapine may be dominated and there are serious side effects, treating severe patients with clozapine is advisable only for patients who do not respond to risperidone and only in the presence of a stricter side effect monitoring system than currently exists.

Long Acting Injectable versus Oral Antipsychotics in Reducing Hospitalization Outcomes in Schizophrenia: A Mirror-Image Study

“…The total direct cost of schizophrenia has been estimated at $2.35 billion per year, 0.3% of GDP while the indirect costs are estimated at upwards of $2 billion yearly (Goeree et al, 2005). Schizophrenia has been estimated to account for 1-3% of total healthcare expenditure (Phanthunane, Vos, Whiteford, & Bertram, 2011). Overall, 79% of the direct costs of schizophrenia result from hospitalization or other residential care (Chue, 2007).…”

A Case of Drug-Induced Acute Dyskinesia Treated with Korean Medicine

“…Suggestions on how to balance safety and effectiveness of clozapine have been given [63]. Other issues can be seen in the added costs associated with blood monitoring and health care system contacts due to the need for gradual titration of clozapine therapy, however, clozapine costeffectiveness has been consistently shown over other agents [64,65]. Recent reports have highlighted the need to inform health professionals about the benefits of treating patients with clozapine [24,[66][67][68][69] and have voiced concern that clozapine is still under utilized especially in patients at risk of suicide [66].…”

Estimating the cost of implementing district mental healthcare plans in five low- and middle-income countries: The PRIME study

“…15 In Thailand, direct medical costs for drug treatment in combination with family interventions cost US$764 per patient per year. 16…”