Cost-effectiveness of an atypical conventional antipsychotic in South Africa: An economic evaluation of quetiapine versus haloperidol in the treatment of patients partially responsive to previous antipsychotics

Abstract

Background. The introduction of a new generation of atypical antipsychotic agents has raised difficult economic and ethical questions, particularly in lower-income countries. The reported tolerability and efficacy advantages of the atypical antipsy- chotics over their conventional predecessors have to be weighed against their higher acquisition costs. Pharmaco-eco- nomic studies conducted in Western countries consistently report cost advantages or cost neutrality for these new agents. However, considerable differences in health care service pro- vision make it difficult to generalise these findings to South Africa.Method. We compared the direct costs (private and public sector) of treating schizophrenia with an atypical antipsychotic quetiapine, and with a conventional antipsychotic haloperidol, by adapting a decision-analytic pharmaco-economic model for South African circumstances. The sample comprised patients partially responsive to antipsychotics, who had partic- ipated in a multinational randomised controlled trial compar- ing the efficacy and safety of quetiapine versus haloperidol. Results. The estimated total direct cost for the treatment with quetiapine in South Africa was slightly less than for haloperidol for various models in both the private and the public sectors.Conclusions. Significant differences in health care provision make pharmaco-economic studies conducted in other coun- tries invalid for South African circumstances. Previously queti- apine treatment did not result in direct cost savings in South Africa. However, the recently introduced legislation to estab- lish single exit prices for medications has resulted in the cost of quetiapine treatment declining by 36.7% and that of haloperi- dol by 13%. This has translated into an overall direct cost sav- ing for quetiapine in both the private and public sector models. This, together with additional indirect advantages of the atypi- cal antipsychotics such as improved quality of life and better social and vocational functioning, argues strongly from both an economic and ethical perspective for the use of atypical antipsychotics in treating schizophrenia in South Africa.

Maximum potential cost-savings attributable to generic substitution of antipsychotics 2008 to 2013

“…Treatment for schizophrenia is extremely costly (Emsley & Booysen, 2004), and therefore patients' health expenditures can be reduced by developing a cost-saving plan through generic substitution (Hamann et al, 2013). By using generic medication, at a lower cost and assured quality of their originator equivalent, health outcomes for both patients and health systems can be achieved at a lower cost.…”

“…In 2011, $12.6 billion was spent on 54 million prescriptions issued for antipsychotics in the United States of America (Leonhauser, 2012). Irrespective of its economic strain on patients themselves, this disease also puts a large economic burden on families, societies and healthcare systems (Emsley & Booysen, 2004). For example, according to Emsley and Booysen (2004), it could cost a family of a schizophrenic patient approximately ZAR 498 771.00 per year to take care of such an individual, while spending approximately 15 h a week taking care of these members.…”

“…This figure, however, did not include schizophrenia and bipolar mood disorder (Williams et al, 2008). When costs of treatment for psychiatric illnesses are compared, schizophrenia is the most costly illness to treat (Emsley & Booysen, 2004). Without healthcare coverage, treatment for schizophrenia can become unaffordable, even if generic medicines are used (Lehman et al 2004).…”