Abstract
BackgroundInformation 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.MethodsA 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.ResultsGeneric 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.ConclusionsThere 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.
Highlights
Information on cost-effectiveness of interventions to treat schizophrenia can assist health policy decision making, given the lack of health resources in developing countries like Thailand
Clozapine had an additional benefit of preventing suicide but greater health loss from weight gain than the other drugs (Table 2)
Intervention had additional health benefits when combined with drug treatment
Summary
Information on cost-effectiveness of interventions to treat schizophrenia can assist health policy decision making, 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. Schizophrenia generally begins in early adulthood and causes long term mental and physical impairment [1]. It has a significant impact on individuals, families and countries in terms of both health and economic loss. In the 1999 Thai Burden of Disease and Injury study, schizophrenia was responsible for 5% of all non-fatal health loss measured in years lived with disability [2]. The. Thailand has limited health resources for mental disorders, including schizophrenia. It is paramount that decision makers have access to cost-effectiveness information to prioritise allocation of resources within their budget constraints
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