Preview

FARMAKOEKONOMIKA. Modern Pharmacoeconomics and Pharmacoepidemiology

Advanced search

Pharmacoeconomic analysis of using typical and atypical antipsychotics in schizophrenia

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

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.



References

1. Gurovich I. Ya., Lyubov E. B. Pharmacoepidemiology and pharmacoeconomics in psychiatry [Farmakoehpidemiologiya i farmakoehkonomika v psihiatrii (in Russian)]. Moscow. 2003; 264 s.

2. Gurovich I. Ya., Lyubov E. B. et al. Social’naya i klinicheskaya psihiatriya (in Russian). 2002; 12 (3): 46-55.

3. Rise D. P. Economic burden of mental disorders in the USA. econom.neurosc. 1999; I: 40-44.

4. YAstrebov V.S. et al. Social’naya i klinicheskaya psihitariya (in Russian). 2009; 19 (4): 21-28.

5. Belousov Yu.B. et al. Psihiatriya i farmakoterapiya (in Russian). 2007; 9 (4): 49-55.

6. Belousov Yu.B. et al. kachestvennaya klinicheskaya praktika (in Russian). 2011; 1: 51-57.

7. Krysanov I. S. et al. Social’naya i klinicheskaya psihiatriya (in Russian). 2017; 27 (2): 88-94.

8. Omel’yanovskij V. V. Social’naya i klinicheskaya psihiatriya (in Russian). 2013; 23 (2): 73-83.

9. Krysanov I. S. et al. kachestvennaya klinicheskaya praktika (in Russian). 2016; 4: 27-34.

10. Etobaeva I. G., Lubsanova S. A., Tyheeva N. A., Rodnaeva O. A. Sovremennye problemy nauki i obrazovaniya (in Russian). 2015; 1(1): 13-24.

11. Krot K. V. et al. kachestvennaya klinicheskaya praktika (in Russian). 2016; 1: 34-40.

12. Janicak P. G. The CATIE study and its implications antipsychotic drug use. essent Psychopharmacol. 2006; 7: 53-63.

13. Kahn R. S. et al. Effectiveness of antipsychotic drugs in firstepisode schizophrenia an schizophreniform disorder: an open randomized clinical trial. Lancet. 2008; 371: 1085-97.

14. Vilyum I. A., Andreev B. V., Proskurin M. A., Balykina YU.E. FARMAkOekOnOMikA. Sovremennaya farmakoekonomika i farmakoepidemiologiya / FARMAkOekOnOMikA. Modern pharmacoeconomics and pharmacoepidemiology (in Russian). 2018; 11 (1): 3-18. https://doi.org/10.17749/2070-4909.2018.11.1.003-018.

15. Vilyum I. A., Andreev B. V., Proskurin M. A., Balykina Yu. E. klinicheskaya farmakologiya i terapiya (in Russian). 2018; 27 (2): 69-76.

16. On the approval of the industry standard “clinical and economic research. General provisions”: Order No. 161 of the Ministry of Health of the Russian Federation of 27.05.2011 [Ob utverzhdenii otraslevogo standarta «kliniko-ehkonomicheskie issledovaniya. Obshchie polozheniya»: prikaz №163 Ministerstva Zdravoohraneniya Rossijskoj Federacii ot 27.05.2011 (in Russian)].

17. Avksent’eva M.A., Gerasimov B. V., Sura M. V. Clinical and economic analysis (assessment, selection of medical technologies and quality management of medical care). Ed. P. A. Vorobyov [klinikoehkonomicheskij analiz (ocenka, vybor medicinskih tekhnologij i upravleniya kachestvom medicinskoj pomoshchi). Pod red. P. A. Vorob’eva (in Russian)]. Moscow. 2004; 404 s.

18. Belousov Yu.B. Planning and conducting clinical trials of medicines [Planirovanie i provedenie klinicheskih issledovanij lekarstvennyh sredstv (in Russian)]. Moscow. 2000; 579 s.

19. Basic concepts in the evaluation of medical technologies: a method. allowance. Under. Ed. AS Kolbin, SK Zyryanov, D. Yu. Belousov [Osnovnye ponyatiya v ocenke medicinskih tekhnologij: metod. posobie. Pod. red. A. S. kolbina, S. k. Zyryanova, D. YU. Belousova (in Russian)]. Moscow. 2013; 42 s.

20. Walley T., Haycox A., Boland A. Pharmacoeconomics. elsevier Health Sciences. 2004; 216 s.

21. Josephine A. Mauskopf et al. Principles of Good Practice for Budget Impact Analysis: Report of the ISPOR Task Force on Good Research Practices – Budget Impact Analysis. Value in Health. 2007; 10 (5); 336-347.

22. Decree of the Government of the Russian Federation of December 12, 2016 N 1403 “On the Program of State Guarantees of Free Medical Assistance to Citizens for 2017 and for the Planning Period of 2018 and 2019” [Postanovlenie Pravitel’stva RF ot 19.12.2016 n 1403 «O Programme gosudarstvennyh garantij besplatnogo okazaniya grazhdanam medicinskoj pomoshchi na 2017 god i na planovyj period 2018 i 2019 godov» (in Russian)].

23. The General Tariff Agreement for St. Petersburg (in Russian). [electronic resource] URL: http://www.spboms.ru/kiop/main?page_id=338. Accessed: 18.04.2018.

24. State Register of Medicines (in Russian). [electronic resource] URL: http://grls.rosminzdrav.ru/Default.aspx. Accessed: 18.04.2018.

25. Russian pharmaceutical portal PHARM-index (in Russian). [electronic resource] URL: https://www.pharmindex.ru/. Accessed: 18.04.2018.

26. Federal Law No. 255-FZ of December 29, 2006 (as amended on 03.12.2011) “On compulsory social insurance in case of temporary incapacity for work and in connection with maternity” [Federal’nyj zakon ot 29.12.2006 n 255-FZ (red. ot 03.12.2011) «Ob obyazatel’nom social’nom strahovanii na sluchaj vremennoj netrudosposobnosti i v svyazi s materinstvom» (in Russian)].

27. The territorial department of the Federal State Statistics Service for St. Petersburg and the Leningrad region, the official website (in Russian). [electronic resource] URL: http://petrostat.gks.ru/. Accessed: 18.04.2018.

28. Lekht S. et al. Social’naya i klinicheskaya psihitariya (in Russian). 2016; 26 (2): 65-71.

29. Davis J. M. et al. A meta-analysis of efficacy of secondgeneration antipsychotics. Arch. Gen. Psychiatry. 2003; 60: 733-759.

30. Newton A. S. Antipsychotics in adult with schizophrenia: comparative effectiveness of fist-generation versus second-generation medications a systematic review and meta-analysis. Ann. int. Med. 2012; 157: 498-511.


Review

For citations:


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

Views: 1627


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