To evaluate the clinical and economic feasibility of using classical (CA) and atypical (AA) antipsychotics for the inpatient treatment of schizophrenia from the perspective of the public health system.
Material and methods
The study was conducted in two consecutive stages: a pharmacoepidemiological analysis of the management of patients with schizophrenia in a psychiatric hospital, and clinical and economic modeling using the obtained data. Two medical technologies were evaluated: CA treatment and AA treatment. Based on the results of a retrospective study, the main characteristics of the patient population for the clinical and economic analysis, as well as the performance indicators were determined. Direct and indirect costs were calculated. Cost-effectiveness analysis, incremental analysis, and budget impact analysis were performed.
The direct costs were higher in case of using reference AA and lower in case of treating with CA (171 073 and 151 144 rubles, respectively). When the reference AAs were completely replaced or were used in 70% of cases, the total direct costs were reduced by 8% and 5%, respectively. Indirect costs for CA and AA were comparable. The AA strategy provided a higher proportion of patients with antipsychotic effect. However, it was associated with higher costs. In evaluating the duration of hospitalization, both strategies showed comparable efficacy, but the AA strategy was more costly. When assessing the proportion of patients with the antipsychotic effect achieved, the CER for CA strategies, reference, reproduced and reference/reproduced AAs was 267 520 rubles, 264 002 rubles, 245 163 rubles, and 250 821 rubles, respectively. In the analysis of the duration of hospitalization, the strategy of CA led to the lowest CER. When comparing both with the strategy of reference AA, and with strategies of reproduced and referenced / reproduced AAs, the use of CA was a more preferable strategy in terms of impact on the budget.
The results of pharmacoeconomic modeling demonstrated the lack of full advantage of any of the evaluated medical technologies over the other one, though it highlighted resource-saving approaches to the treatment of an acute episode of schizophrenia in the hospital.
Schizohrenia, pharmacoteherapy, classical antipsihotics, antipical antipsuchotics, cost-effectiveness analysis, budget impact analysis.