title: Pharmacoeconomic evaluation of schizophrenia in Taiwan: model comparison of long-acting risperidone versus olanzapine versus depot haloperidol based on estimated costs.
abstract: Antipsychotics are the keystone in schizophrenia treatment. Although the benefits of the new generation of antipsychotics has been demonstrated over the last decade, the issues of patient compliance and higher purchasing price of atypical antipsychotics remain unresolved. Risperidone is the only atypical antipsychotic agent with long-acting formulation. Long-acting risperidone is a water-based injection and it has been associated with a low level of pain. The aim of the present study was to test whether an improvement in compliance with the use of a long-acting risperidone, compared with olanzapine and depot haloperidol, can increase the effectiveness and the cost-effectiveness indexes. An economic comparison model with decision tree, rather than a prospective design with real clinical drug trial, was applied. The unit cost for each medical procedure was obtained from the claimed-database of the Bureau of National Health Insurance in Taiwan. An executive committee simulated the incidence of extrapyramidal side-effects and proposed a therapeutic model for each strategy based on a literature review. The probabilities of treatment response of different agents and those of different mental health states were estimated by the executive committee and 10 senior psychiatrists who were randomly selected. Sensitivity analysis was performed for drug cost-effectiveness and compliance improvement for using long-acting risperidone. The results showed that long-acting risperidone is more cost-effective than either olanzapine or depot haloperidol for treating schizophrenia patients whose conditions are stable and whose illness duration ranges from 1 to 5 years. The comparison model with the Kaplan-Meier decision tree may serve as an alternative to prospectively designed studies for cost-effectiveness of atypical antipsychotics.
authors.affiliation: Department of Psychiatry, National Cheng Kung University College of Medicine, Taiwan. ykyang@mail.ncku.edu.tw
authors.forename: Yen Kuang
authors.initials: YK
authors.lastname: Yang
authors.forename: Yen-Huei
authors.initials: YH
authors.lastname: Tarn
authors.forename: Yeng Hui
authors.initials: YH
authors.lastname: Tarn
authors.forename: Ting Ying
authors.initials: TY
authors.lastname: Wang
authors.forename: Chia-Yih
authors.initials: CY
authors.lastname: Liu
authors.forename: Yi-Cheng
authors.initials: YC
authors.lastname: Laio
authors.forename: Yuan-Hwa
authors.initials: YH
authors.lastname: Chou
authors.forename: Shin-Min
authors.initials: SM
authors.lastname: Lee
authors.forename: Chun-Chih
authors.initials: CC
authors.lastname: Chen
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D015331:Cohort Studies; D017046:Cost Savings; D003365:Costs and Cost Analysis; D003663:Decision Trees; D003692:Delayed-Action Preparations; D004409:Dyskinesia, Drug-Induced / Q000191:economics / Q000453:epidemiology; D005260:Female; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008134:Long-Term Care / Q000191:economics; D008297:Male; D008603:Mental Health; D018803:Models, Economic; D000077152:Olanzapine; D010349:Patient Compliance; D011634:Public Health; D018967:Risperidone / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D012559:Schizophrenia / Q000188:drug therapy* / Q000191:economics*; D012565:Schizophrenic Psychology; D013624:Taiwan; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations; D001569:Benzodiazepines; D018967:Risperidone; D000077152:Olanzapine