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Pharmacoeconomic analysis of using typical and atypical antipsychotics in schizophrenia

https://doi.org/10.17749/2070-4909.2018.11.2.009-024

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Abstract

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

Materials and methods. The analysis was conducted by two mutually complementary steps: an epidemiological study on outpatients with schizophrenia, and a subsequent pharmacoeconomic modeling. Two medical technologies were evaluated and compared: treatment with classical antipsychotics (kA) and treatment with atypical antipsychotics (AA). For the clinical and economic analysis of these treatments, we used a number of indices derived from our retrospective study of patients’ medical records. The cost-effectiveness analysis, incremental analysis, and «budget impact» analysis were performed taking into account the direct and indirect costs of the treatments.

Results. We determined the costs of managing outpatients with schizophrenia from the perspective of the healthcare budget and the social burdens; we also looked into the relevance and effectiveness of the current costs at various time intervals – 6, 12 and 24 months. As shown, the treatment strategies involving AA were more budget-consumptive than the kA treatments. even if the treatments were switched to the reproduced AA (up to 100% replacement), the costs would remain to be higher than those for the kA. The «cost-effectiveness» 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 kA. However, when the observation period was increased to 24 months, this economic advantage of AA diminished, and the kA drugs had 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 the use of 100% reference AA or the combined use of reference + reproduced AA was simulated, the treatment with kA remained more economically effective, regardless of the simulated period.

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

About the Authors

I. A. Vilyum
Saint-Petersburg State University ; Pavlov First Saint Petersburg State Medical University, Health Ministry of Russian Federation.
Russian Federation

Vilyum Irina Aleksandrovna – MD, Clinical Pharmacologist, Clinic of high medical technologies of N.I. Pirogov; Assistant  Professor, Department of Clinical Pharmacology and Evidence-based Medicine.

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



B. V. Andreev
Saint-Petersburg State University; Psychiatric hospital №1 named after p.P. Kashchenko.
Russian Federation
Andreev Boris Vladimirovich – MD, Professor & Chair, Department of Pharmacology;  Clinical Pharmacologist. 7-9 Universitetskaya Emb., Sankt-Peterburg 199034, Russia; 154 riv. Fontanka Emb., Sankt-Peterburg 190103; 10 Menkovskaya Str., Nikolskoe 190005, Gatchina area, Leningrad Region.


M. A. Proskurin
Saint-Petersburg State University.
Russian Federation

Proskurin Maxim Alexandrovich – Researcher, Department of Mathematical Modeling of Energy Systems, Faculty of Applied Mathematics and Control Processes.

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



Yu. E. Balykina
Saint-Petersburg State University.
Russian Federation

Balykina Yuliya Efimovna – PhD (Physics & Math), Associate Professor, Department of Mathematical Modeling of Energy Systems, Faculty of Applied Mathematics and Control Processes.

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



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For citation:


Vilyum I.A., Andreev B.V., Proskurin M.A., Balykina Y.E. Pharmacoeconomic analysis of using typical and atypical antipsychotics in schizophrenia. PHARMACOECONOMICS. Modern pharmacoeconomics and pharmacoepidemiology. 2018;11(2):9-24. (In Russ.) https://doi.org/10.17749/2070-4909.2018.11.2.009-024

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ISSN 2070-4909 (Print)
ISSN 2070-4933 (Online)