The Impact of Antipsychotic Polytherapy Costs in the Public Health Care in Sao Paulo, Brazil

Abstract

IntroductionGuidelines 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.ObjectiveTo 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.MethodA 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.Results147 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.ConclusionAntipsychotic 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.

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“…Polypharmacy involving psychotropic drug combinations is common despite the lack of evidence of its efficacy and safety [ 109 ]. The electrophysiological effects of psychotropic drugs used in monotherapy have been studied extensively, however the influence of combined therapy on QTc was not as widely investigated.…”

Medication-related factors of non adherence among patients with schizophrenia and bipolar disorder: Outcome of a cross-sectional survey in Maiduguri, North-eastern Nigeria

“…From the economic perspective, the cost is likely to be more for subjects on polytherapy than for those on monotherapy which might also contribute to non-adherence. Earlier study by Razzouk et al (2015) in Brazil has shown the impact of antipsychotic polytherapy cost on the public health care system and thus advocated for rational monotherapy. A landmark study that has led some credence to this study finding is that of that showed reduced levels of adherence among patients with bipolar disorder on polytherapy.…”

Costs in the Treatment of Schizophrenia in Adults Receiving Atypical Antipsychotics: An 11-Year Cohort in Brazil

“…Our findings contrast with those from more recent studies that indicated medicine costs accounted for approximately 25% of direct healthcare costs of patients with schizophrenia [ 6 , 7 , 14 ]. In Brazil, Razzouk et al [ 18 ] stated that spending on antipsychotic drugs in patients with psychotic disorders may account for about 50% of direct health costs in the SUS. Even considering the methodological particularities of the cost studies, mainly with regard to the cost components of each, one reason for the higher burden of medicines in our study could be that some patients are receiving their pharmacotherapy via the SUS and using the private sector (health plan or direct payment) for outpatient and hospital treatment, since health plans in Brazil usually do not provide for continuous use medication such as antipsychotic drugs.…”