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Pharmacoeconomic assessment of antipsychotic treatment in outpatients with schizophrenia

https://doi.org/10.17749/2070-4909.2018.11.1.003-018

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Abstract

The aim: to provide a comprehensive pharmacoeconomic evaluation of the antipsychotic maintenance therapy in outpatients diagnosed with schizophrenia.

Materials and methods. The analysis was conducted in two mutually complementary stages: an epidemiological study on the management of outpatients with schizophrenia, and a  subsequent pharmacoeconomic modeling. Two medical technologies were evaluated and  compared: treatment with classical antipsychotics (CA) and treatment with atypical  antipsychotics (AA). Based on a retrospective study of patients’ medical records, we selected the  parameters to be used in the clinical and economic analysis of these treatments. Direct and indirect costs were taken into account to perform the cost-effectiveness analysis,  incremental analysis, and «budget impact» analysis.

Results. We determined the costs of managing of outpatients with schizophrenia in relation to the health budget and in relation to the social burdens; the appropriateness and effectiveness of  the present costs was analyzed for different time intervals – 6, 12 and 24 months. As shown, the treatment strategies involving AA were more budget-consumptive than the CA treatments. If the  treatments were switched to the reproduced AA (up to 100% replacement of reference  medications), the costs would remain to be higher than those for the CA. The «costeffectiveness » analysis related to «the proportion of stable patients» for the horizons of 6  and 12 months indicated that the reproduced AA would be more economically effective than the  CA. However, when the observation period is increased to 24 months, this economic advantage of AA disappears, and the CA drugs have a lower CER instead. For the «number of  hospitalization-free days per year», the use of AA was more cost-effective only versus the 100% use of reproduced AA at the simulated horizon of 12 months. When estimated for the use of 100% reference AA or the combined reference + reproduced AA, the treatment with CA  remained more economically effective, regardless of the simulated period.

Conclusion. The pharmacoeconomic simulation of the antipsychotic therapy in outpatients with schizophrenia suggests the ways of treatment optimization. Among them, using AA for the  treatment of at least 15.6% of patients (those who are employed); keeping the ≥60% use of CA  to ensure the optimal resource-saving effect of the treatment; using reproduced AA at the level  of ≥70% (instead of the reference AA similar in efficacy and safety) to keep the treatment economically justified.

About the Authors

I. A. Vilyum
Sankt-Peterburg State University Pavlov First Sankt-Peterburg State Medical University, Health Ministry of Russian Federation
Russian Federation

7-9 Universitetskaya Emb., Sankt-Peterburg 199034, Russia; 154 riv. Fontanka Emb., Sankt-Peterburg 190103, Russia

6-8 L’va Tolstogo Str., 197022 Russia, Sankt-Peterburg

MD, Clinical Pharmacologist, High Medical Technologies Clinic, Pirogov Saint-Petersburg State University; Assistant Professor, Department of Clinical  Pharmacology and Evidence-based Medicine, First St. Petersburg State Medical University



B. V. Andreev
Sankt-Peterburg State University Kashchenko Psychiatric hospital №1
Russian Federation

7-9 Universitetskaya Emb., Sankt-Peterburg 199034, Russia; 154 riv. Fontanka Emb., Sankt-Peterburg 190103, Russia

10 Menkovskaya Str., Nikolskoe 190005, Gatchina area, Leningrad Region, Russia

MD, Professor & Chair, Department of Pharmacology, St. Petersburg State University; Clinical Pharmacologist, Kashchenko Psychiatric Hospital №1, St. Petersburg



M. A. Proskurin
Sankt-Peterburg State University
Russian Federation

7-9 Universitetskaya Emb., Sankt-Peterburg 199034, Russia; 154 riv. Fontanka Emb., Sankt-Peterburg 190103, Russia

Researcher, Department of Mathematical Modeling of Energy Systems, Faculty of Applied Mathematics and Control Processes, St. Petersburg State University

 



Yu. E. Balykina
Sankt-Peterburg State University
Russian Federation

7-9 Universitetskaya Emb., Sankt-Peterburg 199034, Russia; 154 riv. Fontanka Emb., Sankt-Peterburg 190103, Russia

PhD (Physics & Math), Associate Professor, Department of Mathematical Modeling of Energy Systems, Faculty of Applied Mathematics and Control Processes, St. Petersburg State University



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For citation:


Vilyum I.A., Andreev B.V., Proskurin M.A., Balykina Y.E. Pharmacoeconomic assessment of antipsychotic treatment in outpatients with schizophrenia. FARMAKOEKONOMIKA. Modern Pharmacoeconomic and Pharmacoepidemiology. 2018;11(1):3-18. (In Russ.) https://doi.org/10.17749/2070-4909.2018.11.1.003-018

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