Analisi farmacoeconomica del trattamento di pazienti psicotici cronici con olanzapina, antipsicotici atipici e neurolettici tipici: uno studio regionale

Felice Vadruccio, Giovanni Biricolti, Leonardo Mendolicchio

DOI: https://doi.org/10.7175/fe.v6i2.829

Abstract

BACKGROUND: Psychotic disorders are a ravaging and costly mental illness. Treatment of these disorders involves pharmacological and non pharmacological resources. Pharmacological therapy with antipsychotic drugs contribute strongly to relieve psychotic patients symptoms. By the end of 90’s the new atypical antipsychotic have been introduced. This kind of drugs is supposed to be more effective but also more expensive compared with the old typical neuroleptics. OBJECTIVE: To compare costs and outcomes associated with 12 months treatment of psychotic disorders using typical and atypical antipsychotics in addition to psychiatric services. Moreover to extend the same comparison among the atypical drugs currently used in the clinical practice (olanzapine, risperidone, quetiapine and clozapine). METHODS AND PATIENTS: A multicentre observational study was carried out in 131 patients affected by psychotic disorders (schizophrenia and bipolar). Data were collected with reference to patients followed by several Psychiatric Services of Regione Puglia (Italy). Patients were classified in five groups (typical neuroleptics, olanzapine, risperidone, quetiapine and clozapine) according to their main antipsychotic therapy. Treatment outcomes had been assessed during 12 months of observation considering the patients improvement in their work and social functioning. For these patients we analyzed pharmacological, non pharmacological (medical/ nurse visits, social assistance, rehabilitative sessions) and hospital interventions, choosing the perspective of the Italian Mental Health Centers for costs attribution. Moreover indirect costs (caregiver) and private assistance to the patient had been evaluated for each group of treatment. The study is based on the observation of real clinical behaviours; therefore patients are not randomised to different treatments. RESULTS: The analysis of treatment outcomes didn’t generate significant differences among the groups despite a positive trend in terms of work functioning in favor of olanzapine. The pharmacological interventionts evidentiated an economic significant advantage (p<0,05) in the typical group, compared to all atypical groups, due to the cheaper cost of these drugs. However the overall costs of treatment (pharmacological and non pharmacological resources) didn’t evidentiate significant differences between typical and atypical agents. The comparison among atypical drugs showed a significant (p=0,0426) overall cost advantage of olanzapine group (8.843 euros) compared to quetiapine group (12.344 euros). Moreover the finding from this study suggest that olanzapine leads to reduce in the long term the caregiver costs avoiding at the same time the use of the private assistance for the chronic psychotic patient. CONCLUSIONS: Within the local clinical context, olanzapine appears to provide advantages over the other antipsychotics considering the reduction, statistically significant, in total healthcare resources utilization and savings in terms of costs of caregiver and private assistance related to its use.

Keywords

Psychotic disorders; Costs; Outcomes; Typical neuroleptics; Atypical antipsychotics

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