title: The impact of antipsychotic polytherapy costs in the public health care in Sao Paulo, Brazil.
abstract: BACKGROUND
  Guidelines for the treatment of psychoses recommend antipsychotic monotherapy. However, the rate of antipsychotic polytherapy has increased over the last decade, reaching up to 60% in some settings. Studies evaluating the costs and impact of antipsychotic polytherapy in the health system are scarce.
  
  
  OBJECTIVE
  To estimate the costs of antipsychotic polytherapy and its impact on public health costs in a sample of subjects with psychotic disorders living in residential facilities in the city of Sao Paulo, Brazil.
  
  
  METHODS
  A cross-sectional study that used a bottom-up approach for collecting costs data in a public health provider's perspective. Subjects with psychosis living in 20 fully-staffed residential facilities in the city of Sao Paulo were assessed for clinical and psychosocial profile, severity of symptoms, quality of life, use of health services and pharmacological treatment. The impact of polytherapy on total direct costs was evaluated.
  
  
  RESULTS
  147 subjects were included, 134 used antipsychotics regularly and 38% were in use of antipsychotic polytherapy. There were no significant differences in clinical and psychosocial characteristics between polytherapy and monotherapy groups. Four variables explained 30% of direct costs: the number of antipsychotics, location of the residential facility, time living in the facility and use of olanzapine. The costs of antipsychotics corresponded to 94.4% of the total psychotropic costs and to 49.5% of all health services use when excluding accommodation costs. Olanzapine costs corresponded to 51% of all psychotropic costs.
  
  
  CONCLUSIONS
  Antipsychotic polytherapy is a huge economic burden to public health service, despite the lack of evidence supporting this practice. Great variations on antipsychotic costs explicit the need of establishing protocols for rational antipsychotic prescriptions and consequently optimising resource allocation. Cost-effectiveness studies are necessary to estimate the best value for money among antipsychotics, especially in low and middle income countries.
authors: Centro de Economia em Saúde Mental (CESM), Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Sao Paulo, Brazil.
authors: Denise
authors: D
authors: Razzouk
authors: Centro de Economia em Saúde Mental (CESM), Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Sao Paulo, Brazil.
authors: Monica
authors: M
authors: Kayo
authors: Centro de Economia em Saúde Mental (CESM), Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Sao Paulo, Brazil.
authors: Aglaé
authors: A
authors: Sousa
authors: Centro de Economia em Saúde Mental (CESM), Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Sao Paulo, Brazil.
authors: Guilherme
authors: G
authors: Gregorio
authors: Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Sao Paulo, Brazil.
authors: Hugo
authors: H
authors: Cogo-Moreira
authors: Centro de Economia em Saúde Mental (CESM), Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Sao Paulo, Brazil.
authors: Andrea Alves
authors: AA
authors: Cardoso
authors: Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Sao Paulo, Brazil.
authors: Jair de Jesus
authors: Jde J
authors: Mari
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000191:economics* / Q000627:therapeutic use; D001569:Benzodiazepines / Q000191:economics* / Q000627:therapeutic use; D001938:Brazil; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000191:economics*; D000077152:Olanzapine; D010818:Practice Patterns, Physicians' / Q000191:economics; D011618:Psychotic Disorders / Q000188:drug therapy / Q000191:economics* / Q000503:physiopathology; D011634:Public Health / Q000191:economics; D011788:Quality of Life
chemical_list: D014150:Antipsychotic Agents; D001569:Benzodiazepines; D000077152:Olanzapine