Cost-effectiveness of therapeutic interventions in schizophrenia

Abstract

BackgroundVarious studies have reported that a decision-tree analysis is useful to evaluate different treatment strategies in real clinical practice. ObjectiveThe main aim of this study was to research the clinical decisions regarding the treatment of patients who were diagnosed with schizophrenia. MethodCost-effectiveness study of three different interventions to treat patients with schizophrenia were studied. Interventions were divided into the following categories: a) day hospital (psycho-educational treatment+psychiatric consultation+psychopharmacological treatment); b) therapy adherence clinic (psychopharmacological treatment with depot antipsychotic medication+psychiatric consultation); c) outpatient psychiatric care (psychopharmacological treatment+psychiatric consultation). For this purpose decision tree model was designed and three outcomes were measured (therapeutic compliance, non-compliance and rehospitalization). TreeAge software was used in order to estimate outcome probabilities and sensitivity analysis, distribution Beta for probabilities and Gamma for cost of interventions. ResultsThe probability of therapeutic compliance and average semestral cost of therapy adherence clinic, outpatient psychiatric care and day hospital are 0.594, 0.284, 2.393, and mean cost intervention US$ 2145.6, US$ 700.2 and US$ 1412.1 respectively (IC95%), according to Montecarlo analysis. ConclusionsAccording to the results, the clinical decision to treat patients in therapy adherence clinic improved therapeutic compliance, but the cost of treatment was higher. There were extra costs and risks to society and patient that are associated with therapeutic non-compliance. It is less expensive for the health care system to provide the patients outpatient psychiatric care, but perhaps in the long-term outpatient psychiatric care is more costly for the patient, their family, and society. According to the many important limitations of this study, further studies are needed to reject/confirm these strategies to be included in real clinical practice.