Cost-effectiveness of pharmacological and psychosocial interventions for schizophrenia

Phanthunane, Pudtan, Vos, Theo, Whiteford, Harvey and Bertram, Melanie (2011) Cost-effectiveness of pharmacological and psychosocial interventions for schizophrenia. Cost Effectiveness and Resource Allocation, 9 6.1-6.9. doi:10.1186/1478-7547-9-6


Author Phanthunane, Pudtan
Vos, Theo
Whiteford, Harvey
Bertram, Melanie
Title Cost-effectiveness of pharmacological and psychosocial interventions for schizophrenia
Journal name Cost Effectiveness and Resource Allocation   Check publisher's open access policy
ISSN 1478-7547
Publication date 2011-05-13
Sub-type Article (original research)
DOI 10.1186/1478-7547-9-6
Open Access Status DOI
Volume 9
Start page 6.1
End page 6.9
Total pages 9
Place of publication London, United Kingdom
Publisher BioMed Central
Collection year 2012
Language eng
Formatted abstract
Background:
Information on cost-effectiveness of interventions to treat schizophrenia can assist health policy decision making, particularly given the lack of health resources in developing countries like Thailand. This study aims to determine the optimal treatment package, including drug and non-drug interventions, for schizophrenia in Thailand.

Methods:

A Markov model was used to evaluate the cost-effectiveness of typical antipsychotics, generic risperidone, olanzapine, clozapine and family interventions. Health outcomes were measured in disability adjusted life years. We evaluated intervention benefit by estimating a change in disease severity, taking into account potential side effects. Intervention costs included outpatient treatment costs, hospitalization costs as well as time and travel costs of patients and families. Uncertainty was evaluated using Monte Carlo simulation. A sensitivity analysis of the expected range cost of generic risperidone was undertaken.

Results:
Generic risperidone is more cost-effective than typicals if it can be produced for less than 10 baht per 2 mg tablet. Risperidone was the cheapest treatment with higher drug costs offset by lower hospital costs in comparison to typicals. The most cost-effective combination of treatments was a combination of risperidone (dominant intervention). Adding family intervention has an incremental cost-effectiveness ratio of 1,900 baht/DALY with a 100% probability of a result less than a threshold for very cost-effective interventions of one times GDP or 110,000 baht per DALY. Treating the most severe one third of patients with clozapine instead of risperidone had an incremental cost-effectiveness ratio of 320,000 baht/DALY with just over 50% probability of a result below three times GDP per capita.

Conclusions:

There are good economic arguments to recommend generic risperidone as first line treatment in combination with family intervention. As the uncertainty interval indicates the addition of clozapine may be dominated and there are serious side effects, treating severe patients with clozapine is advisable only for patients who do not respond to risperidone and only in the presence of a stricter side effect monitoring system than currently exists.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2012 Collection
School of Public Health Publications
 
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Created: Wed, 12 Oct 2011, 01:05:56 EST by Geraldine Fitzgerald on behalf of School of Public Health