PMH12 COST-EFFECTIVENESS OF TYPICALS, ATYPICALS AND PSYCHOSOCIAL INTERVENTIONS FOR SCHIZOPHRENIA IN THAILAND

Abstract

Objectives: 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 considered health outcomes from a change in disease severity; extrapyradimal symptoms and weight gain as side effects; and a reduction in suicide (for clozapine only). Intervention costs included treatment cost, hospitalization cost as well as time and travel cost of patients and families. Uncertainty was evaluated using multivariate Monte Carlo simulation. As a generic version of risperidone is expected on the market soon, a sensitivity analysis of varying costs of risperidone was undertaken. Results: The cost-effectiveness results indicate generic risperidone, assuming a cost of 4 baht per 2-mg tablet will improve health outcomes and save costs if replacing the currently predominant treatment of typical drugs. The ideal combination of treatments is risperidone as fi rst line treatment (dominant intervention), adding family interventions for all patients (Incremental cost-effectiveness ratio of 2000 baht/ DALY) and adding clozapine to severe patients (an estimated 33% of patients). This addition has an incremental cost-effectiveness ratio of 290,000 baht/DALY, which is still less than three times GDP per capita. Conclusions: The introduction of generic risperidone will lead to more effi cient outcomes and lower costs if it can be produced for less than 10 baht per 2-mg tablet. Providing family interventions for all patients and treating more severe patients with clozapine can further improve outcomes of Thai patients with schizophrenia in a cost-effective manner.