Cost-Effectiveness Analysis Of Lurasidone And Olanzapine In The Treatment Of Schizophrenia

Abstract

A 1 -A 3 1 8 a median age of 41 years old. Median spending per patient with medicines was USD 490.56. All patients used antipsychotics, which accounted by 93.8% of the total spending with high cost drugs and had a median spending USD 516.40, followed by anti-dementia drugs (5.8% of patients; 3.6% of spending; and median spending USD 635.77); dopaminergic agents (2.0%; 0.6%; and USD 107.95) and antiepileptics (2.8%; 0.6%; and USD 209.48). ConClusions: Spending on atypical antipsychotics suggests that the use of these medicines needs to be carefully evaluated and monitored to optimize health resources allocation. Furthermore, the SUS may be reaching good results in terms of coverage of these drugs for patients, considering the number of identified patients, the Brazilian population and the prevalence of schizophrenia in the world. The use of dopaminergic agents can be associated with adverse reactions caused by the use of antipsychotics. More specific studies are necessary to determine the relationship between schizophrenia and the use of anti-dementia drugs.objeCtives: Managing schizophrenia remains challenging because ~25% of patients do not respond to antipsychotics while ~15% have intolerable side effects. Prescribers lack tools to determine the cause of these complicated treatment courses and respond appropriately. We estimate the potential cost savings from having point-of-care access to antipsychotic plasma levels to guide treatment decisions. Methods: Based on literature estimates nonresponse is caused by poor adherence (80% of patients), true treatment resistance (16%) and rapid drug metabolism (4%), and intolerable side effects are caused by slow metabolism (73%) and high sensitivity (27%). We assumed that in the absence of plasma level information, prescribers cannot ascertain those root causes but employ two heuristics to manage these patients, one attributing all cases to the most common cause, the other randomly applying the underlying distribution of causes. We calculated the proportion of patients in whom heuristic-based decisions would be incorrect and assumed that the outcome would be poor symptom control, whereas correctly managed patients would have well controlled schizophrenia. We used published costs of well versus poorly controlled schizophrenia to estimate potential savings from point-of-care access to plasma levels. Results: Without antipsychotic plasma levels, prescribers would make incorrect decisions in 20% to 34% of nonresponders and 27% to 39% of patients with intolerable side effects. Annual healthcare costs for well and poorly controlled patients are $15,318 and $49,589 in 2015 dollars, respectively, suggesting avoidable costs of $34,271 in incorrectly managed patients. Access to plasma level Information would reduce annual cost between $6,854 and $13,366 for each patient with complicated treatment course. ConClusions: Access to point-of-care antipsychotic plasma levels would reduce incorrect management decisions for one to two-fifths of the ~40% of patients with complicated treatme...