Abstract
OBJECTIVES: We aimed to evaluate the clinical, societal and economic outcomes of olanzapine treatment compared to treatment with standard antipsychotics in out-patients with multiple schizophrenic episodes and subsequent yearly rehospitalizations. METHODS: The present study comprised two stages. Within the first (clinical) stage a mirror image 24-week cost-effectiveness study was performed. Data were evaluated from 30 schizophrenic patients (ICD-10). Drug efficacy assessment included PANSS. Social functioning was evaluated with the original checklist. Economic analysis based on resource utilization data. Within the second stage a Markov simulation model over a hypothetical 5-year period has been developed to compare the overall costs and cost-effectiveness of olanzapine with those of standard treatment. RESULTS: During the maintenance phase of the study, olanzapine-treated patients achieved a statistically significant greater improvement than ones treated with standard antipsychotics on overall measures of effectiveness. In spite of high acquisition cost of olanzapine, total medical costs were not significantly more (nearly 10 %). Incremental cost-effectiveness ratio for olanzapine of 5 roubles (1998 values) per disability-free day gained over the trial period. The direct cost per patient was calculated to be 56000 roubles higher for 5-yeara therapy with olanzapine. However the net savings per olanzapine-treated patient was 40.000 roubles from societal perspective by significantly increasing productivity and producing more time in a disability-free state. The results of analysis were not robust in a sensitivity analysis, including variations in the frequency, duration and/or cost of hospitalization and/or acquisition cost of olanzapine. CONCLUSIONS: Olanzapine offered an economically justifiable therapeutic option in the long-term management of the special subpopulation of patients with frequent rehospitalizations.
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