A PHARMACOECONOMIC MODEL OF OUTPATIENT ANTIPSYCHOTIC THERAPY IN REVOLVING-DOOR SCHIZOPHRENIC-PATIENTS

Background: The discrepancy between supply and demand in health care t oday requires that psychiatrists and other providers of patient care e xpand their traditional role from one of patient advocate to one of al locator of care. In this new role, the care provider must consider not only the efficacy and safety of a therapeutic regimen, but also its i mpact on society in terms of quality of life and cost-effectiveness. M ethod: A variety of pharmacoeconomic analysis methodologies have been used to assess the economic and quality of life consequences of altern ate treatment strategies. A clinical decision analysis model that take s into account compliance rates and associated rehospitalization was u sed to compare the direct treatment costs associated with alternate ou tpatient neuroleptic strategies for ''revolving door'' schizophrenic p atients. The antipsychotic treatment options considered were tradition al oral neuroleptics (e.g., haloperidol), depot neuroleptics (e.g., ha loperidol decanoate), and ''atypical'' oral agents (e.g., risperidone) . Results: The results of this decision analysis model (based on a set of reasonable outcome probabilities and costs) suggest that, under fi ve sets of cost and outcome assumptions, switching to the depot route in a patient with a history of relapse and rehospitalization may reduc e total direct treatment costs by approximately $650 to $2600/year com pared with an atypical agent and approximately $460 to $1150/year comp ared with a traditional oral neuroleptic. Under a sixth set of assumpt ions-namely, a compliance rate with atypical oral drug (80%) equal to that with the depot agent and an average wholesale price of the atypic al drug 25% lower than current wholesale price-the atypical oral drug treatment option would be approximately $700 less than treatment with a depot agent, and $1860 less than treatment with a traditional neurol eptic. Conclusion: The decision analysis model presented here indicate s that, under a variety of assumptions, switching a revolving door pat ient to a depot medication for outpatient maintenance therapy could re sult in lower total direct treatment costs over the first year. This f inding was consistent, although to varying degrees, under differing pr obability and cost assumptions. The proposed model can be used in othe r clinical circumstances, such as treatment-refractory patients or tho se with severe negative symptoms, as well as with other associated out come probabilities and costs. Application of this model in different c linical scenarios associated with different outcome probabilities and treatment costs, however, may well provide different results.