title: A Cost-effectiveness Analysis of Antipsychotics for Treatment of Schizophrenia in Uganda.
abstract: BACKGROUND
  Reductions in prices following the expiry of patents on second-generation antipsychotics means that they could be made available to patients with schizophrenia in low-income countries. In this study we examine the cost effectiveness of antipsychotics for schizophrenia in Uganda.
  
  
  METHODS
  We developed a decision-analytic 10-state Markov model to represent the clinical and treatment course of schizophrenia and the experience of the average patient within the Uganda healthcare system. The model was run for a base population of 25-years-old patients attending Butabika National Referral Mental Hospital, in annual cycles over a lifetime horizon. Parameters were derived from a primary chart abstraction study, a local community pharmacy survey, published literature, and expert opinion where necessary. We computed mean disability-adjusted life-years (DALYs) and costs (in US$ 2012) for each antipsychotic, incremental cost, and DALYs averted as well as incremental cost-effectiveness ratios (ICERs).
  
  
  RESULTS
  In the base-case analysis, mean DALYs were highest with chlorpromazine (27.608), followed by haloperidol (27.563), while olanzapine (27.552) and risperidone had the lowest DALYs (27.557). Expected costs were highest with quetiapine (US$4943), and lowest with risperidone (US$4424). Compared to chlorpromazine, haloperidol was a dominant option (i.e. it was less costly and more effective); and risperidone was dominant over both haloperidol and quetiapine. The ICER comparing olanzapine to risperidone was US$5868 per DALY averted.
  
  
  CONCLUSIONS
  When choosing between first-generation antipsychotics, clinicians should consider haloperidol as the first-line agent for schizophrenia. However, overall, risperidone is a cost-saving strategy; policymakers should consider its addition to essential medicines lists for treatment of schizophrenia in Uganda.
authors.affiliation: Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Seattle, Washington, USA. slubinga@uw.edu.|Global Medicines Program, Department of Global Health, University of Washington, Seattle, Washington, USA. slubinga@uw.edu.
authors.forename: Solomon J
authors.initials: SJ
authors.lastname: Lubinga
authors.affiliation: Butabika National Referral Hospital for Mental, Neurological and Substance Abuse Disorders, Kampala, Uganda.
authors.forename: Byamah B
authors.initials: BB
authors.lastname: Mutamba
authors.affiliation: Kadic Hospital, Kampala, Uganda.
authors.forename: Angelo
authors.initials: A
authors.lastname: Nganizi
authors.affiliation: Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Seattle, Washington, USA.|Global Medicines Program, Department of Global Health, University of Washington, Seattle, Washington, USA.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Babigumira
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D001569:Benzodiazepines / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D002746:Chlorpromazine / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D006220:Haloperidol / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D017048:Health Care Costs; D006801:Humans; D008875:Middle Aged; D000077152:Olanzapine; D019057:Quality-Adjusted Life Years; D018967:Risperidone / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D012559:Schizophrenia / Q000188:drug therapy / Q000191:economics*; D014454:Uganda
chemical_list: D014150:Antipsychotic Agents; D001569:Benzodiazepines; D006220:Haloperidol; D018967:Risperidone; D000077152:Olanzapine; D002746:Chlorpromazine