Abstract
the primary objective was to create an interactive model to analyze the budget impact of maintenance therapy with different antipsychotics (APs) from the Russian hospital perspective. an interactive, customizable model in Excel was built to calculate the costs and to provide pharmacoeconomic assessment of antipsychotic therapy. Cost-minimization (CMA), cost-effectiveness (CEA) and budget impact analysis (BIA) were used to conduct economic evaluation of standard doses therapy (according to national guidelines) of APs. Data on antipsychotics used in the long-term treatment of schizophrenia were derived from meta-analysis. Mean standard treatment duration was 60 days in inpatients facilities. Costs for drugs were estimated from the national hospitals sources (2015). Exchange rate in the analyzed period was €1 = 71.8 RUB. CMA showed, that clozapine demonstrated the lowest costs per patient (€25) followed by olanzapine (€202) with the assumption that they have similar effectiveness. Olanzapine was associated with higher drug costs relative to haloperidol (€202 vs. €2.3), but also had statistically significantly greater total effectiveness - mean relapse prevention rate was 83% and 72% respectively (OR=0.50, 95% CI 0.30–0.82). The ICER for olanzapine (€1,818) was 15 times less than willingness to pay the threshold for Russia (3-times GDP). The developed evaluation instrument enabled to estimate the budget impact of olanzapine (greater effectiveness) for two identical cohorts (n=200) of patients with schizophrenia: the model predicted a 18.6% increase in net costs for olanzapine in case of increase by 5% its utilization with an alternative haloperidol decreases in the same proportion (with base case proportion 24 and 76% respectively). results suggest that direct inpatients costs on mental healthcare could be minimized by using clozapine instead of olanzapine. In comparison with haloperidol the use of olanzapine in the treatment of schizophrenia is the cost-effective alternative for the Russian National health service.
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