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González GP, Moscoso NS, Lago FP. A Review of Clinical and Economic Evaluations Applied to Psychotropic Therapies Used in the Treatment of Schizophrenia in Argentina. PHARMACOECONOMICS - OPEN 2018; 2:233-239. [PMID: 29623634 PMCID: PMC6103928 DOI: 10.1007/s41669-017-0058-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Schizophrenia is considered a serious mental disorder that affects over 21 million people worldwide, and is associated with disability that frequently affects the patient's educational and working performance. In Argentina, two of the most widely used antipsychotics in the treatment of this disorder are haloperidol and risperidone. Both are provided free to patients without health coverage in public healthcare facilities. In this paper we seek to review the clinical and economic benefits of prescribing psychotropic therapies based on haloperidol (a first-generation antipsychotic that is part of the butyrophenone group of drugs) versus risperidone [an atypical or second-generation antipsychotic (neuroleptic) drug] in adult patients who have been diagnosed with schizophrenia. To achieve this objective, an exhaustive search of relevant articles published between 2006 and April 2017 was conducted. This literature search showed that intermittent treatment usually fails to prevent relapses due to irregular protection, therefore continuous treatment is more effective. Although the injectable formats of both drugs [haloperidol depot and long-acting injectable risperidone (LAIR)] have not proven to have significant differences with regard to clinical effectiveness vis-à-vis the tablet formats, they showed a lower cost-effectiveness ratio by reducing patients' relapses. Moreover, LAIR exhibits superior cost effectiveness compared with haloperidol depot. Haloperidol is less expensive than risperidone but is less cost effective; in comparison with haloperidol, treatment with risperidone produces (1) an improvement in quality-adjusted life-years, and (2) a significant reduction in negative symptoms. In most cases, antipsychotic treatments are effective in controlling the positive and negative symptoms associated with schizophrenia, allowing patients to live in their communities without any impairments. However, it is extremely important to combine pharmacological treatment with other measures that constitute psychosocial therapy.
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Affiliation(s)
| | - Nebel Silvana Moscoso
- Institute of Economic and Social Research of the South (IIESS-CONICET-UNS), Bahía Blanca, Buenos Aires, Argentina
| | - Fernando Pablo Lago
- Institute of Economic and Social Research of the South (IIESS-CONICET-UNS), Bahía Blanca, Buenos Aires, Argentina
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Abstract
After the identification of the influence of serotonergic receptors in ameliorating the negative symptoms associated with schizophrenia, atypical antipsychotics were developed by incorporating dopamine and serotonin antagonism. Risperidone, sold under the trade name Risperdal, was the second atypical antipsychotic developed following clozapine but quickly became a first-line treatment for acute and chronic schizophrenia because of its preferential side effect profile. Despite initial Food and Drug Administration approval 25 years ago, risperidone continues to be a fundamental treatment for schizophrenia, bipolar I disorder, and autism-related irritability. It is on the World Health Organization's List of Essential Medicines for its balance of efficacy, safety, tolerability, and cost-effectiveness. In this review, we highlight the history and importance of risperidone as an atypical antipsychotic, in addition to its chemical synthesis, manufacturing, drug metabolism and pharmacokinetics, pharmacology, structure-activity relationship, indications, and adverse effects.
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Affiliation(s)
- Trevor C. Chopko
- Vanderbilt Center for Neuroscience Drug Discovery, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, United States
| | - Craig W. Lindsley
- Vanderbilt Center for Neuroscience Drug Discovery, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, United States
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, United States
- Department of Chemistry, Vanderbilt Institute of Chemical Biology, Vanderbilt University, Nashville, Tennessee 37232, United States
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Abstract
OBJECTIVES To review the published literature on aripiprazole once monthly, a second generation antipsychotic (SGA) recently developed as a long-acting injection (LAI), in the form of a suspension of lyophilized aripiprazole reconstituted with an aqueous diluent, for intramuscular administration. METHODS An electronic database search was conducted using the key words; relevant articles were then hand searched and websites (FDA, EMA, Otsuka, Lundbeck, NIH) reviewed. RESULTS Efficacy has been demonstrated in preventing relapse in a 52 week study versus placebo, and non-inferiority to oral aripiprazole in a 38 week study, as well as in the treatment of hospitalized adult patients with acutely relapsed schizophrenia. Aripiprazole LAI appears cost-effective versus other SGA-LAIs, with improved health-related quality of life and functioning in a head-to-head study with paliperidone LAI. A 6 month (pre and post), mirror-image switch study demonstrated a reduction in hospitalization and associated costs compared with previous antipsychotic treatment. Safety and tolerability are comparable to oral aripiprazole with no new safety signals. CONCLUSIONS Experience with oral aripiprazole and the current availability of the long-acting formulation suggest a potential benefit in a variety of clinical scenarios and therefore consideration as a treatment option in the treatment of schizophrenia.
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Affiliation(s)
- Pierre Chue
- a University of Alberta , Edmonton, Alberta , Canada
| | - James Chue
- b Clinical Trials and Research Program , Edmonton, Alberta , Canada
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Abstract
BACKGROUND Bipolar 1 disorders (BPD) are a chronic disorder with prevalence rates of up to 2.6% of the adult population or higher and appreciable direct and indirect costs. As a result, these are a concern to health authorities especially given the low age of onset. Consequently, there is a need to treat BPD patients well and improve their quality-of-life. Pharmacotherapy includes mood stabilizers and atypical antipsychotics (AAPs). AAPs have different mechanisms of action and side-effects, so treatment needs to be tailored. Asenapine in clinical trials is as effective as olanzapine, with less metabolic side-effects. METHODS Chitnis and colleagues assessed the cost-effectiveness of asenapine among patients in healthcare databases. RESULTS AND CONCLUSION They showed in routine care that asenapine also reduces hospital and emergency room admissions, making it cost neutral in BPD, which is of interest to health authorities and clinicians.
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Affiliation(s)
- Brian Godman
- a a Department of Laboratory Medicine, Division of Clinical Pharmacology , Karolinska Institutet, Karolinska University Hospital Huddinge , Stockholm , Sweden
- b b Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde , Glasgow , UK
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Samalin L, Nourry A, Charpeaud T, Llorca PM. What is the evidence for the use of second-generation antipsychotic long-acting injectables as maintenance treatment in bipolar disorder? Nord J Psychiatry 2014; 68:227-35. [PMID: 23795859 DOI: 10.3109/08039488.2013.801078] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND In recent years, the use of second-generation antipsychotics long-acting injectable in the maintenance treatment of bipolar disorder has sparked interest in improving adherence and reducing the risk of relapse. AIMS This report aims to review the available evidence concerning the use of second-generation antipsychotics depot in bipolar disorder and specify the typology of patients that could be eligible for this formulation. METHODS A systematic review of the literature was conducted using Pubmed and EMBASE. RESULTS Data available for the clinician assessing the interests of second-generation antipsychotics depot in long-term treatment of bipolar disorder are limited to risperidone. It seems particularly relevant for bipolar patients with poor adherence or early in the course of illness and can be used as monotherapy with manic polarity. It should always be considered for use in combination with at least one other mood stabilizer in patients with depressive polarity. As for other medications, the benefit/risk ratio for a long-acting should be evaluated individually. CONCLUSIONS If using a depot formulation could be considered for all patients in order to approach a perfect compliance, patients with certain clinical profiles could be an argument for prioritizing the use of long-acting injectable as maintenance treatment. Additional studies are needed with other second-generation antipsychotics depot in bipolar patients to generalize their use in the maintenance treatment of bipolar disorder but the future golden standard of studies with long-acting formulations remains to be defined.
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Affiliation(s)
- Ludovic Samalin
- Department of Psychiatry B, University of Auvergne , 63000 Clermont-Ferrand , France
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von Schéele B, Mauskopf J, Brodtkorb TH, Ainsworth C, Berardo CG, Patel A. Relationship between modeling technique and reported outcomes: case studies in models for the treatment of schizophrenia. Expert Rev Pharmacoecon Outcomes Res 2014; 14:235-57. [DOI: 10.1586/14737167.2014.891443] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Einarson TR, Zilbershtein R, Skoupá J, Veselá S, Garg M, Hemels MEH. Economic and clinical comparison of atypical depot antipsychotic drugs for treatment of chronic schizophrenia in the Czech Republic. J Med Econ 2013; 16:1089-95. [PMID: 23808900 DOI: 10.3111/13696998.2013.820193] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE The Czech Republic is faced with making choices between pharmaceutical products, including depot injectable antipsychotics. A pharmacoeconomic analysis was conducted to determine the cost-effectiveness of atypical depots. METHODS An existing 1-year decision-analytic framework was adapted to model drug use in this healthcare system. The average direct costs to the General Insurance Company of the Czech Republic of using paliperidone palmitate (Xeplion®), risperidone (Risperdal Consta®), and olanzapine pamoate (Zypadhera®) were determined. Literature-derived clinical rates populated the model, with costs adjusted to 2012 Euros using the consumer price index. Outcomes included quality-adjusted life-years (QALYs), days in remission, and proportions hospitalized or visiting emergency rooms. One-way sensitivity analyses were calculated for all important inputs. A multivariate probability analysis was used to examine the stability of results using 10,000 iterations of simulated input over reasonable ranges of all included variables. RESULTS Expected average costs/per patient treated were €5377 for PP-LAI, €6118 for RIS-LAI, and €6537 for OLZ-LAI. Respective QALYs were 0.817, 0.809, and 0.811; ER visits were 0.127, 0.134, and 0.141; hospitalizations were 0.252, 0.298, and 0.289. Results were generally robust in sensitivity analyses. PP-LAI dominated RIS-LAI and OLZ-LAI in 90.2% and 92.1% of simulations, respectively. Results were insensitive to drug prices but sensitive to adherence and hospitalization rates. CONCLUSIONS PP-LAI dominated the other two drugs, as it had a lower overall cost and superior clinical outcomes, making it the preferred choice. Using PP-LAI in place of RIS-LAI for chronic relapsing schizophrenia would reduce the overall costs of care for the healthcare system.
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Godman B, Persson M, Miranda J, Barbui C, Bennie M, Finlayson AE, Raschi E, Wettermark B. Can authorities take advantage of the availability of generic atypical antipsychotic drugs? Findings from Sweden and potential implications. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2013. [DOI: 10.1111/jphs.12025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Brian Godman
- Department of Laboratory Medicine; Division of Clinical Pharmacology; Karolinska Institute; Karolinska University Hospital Huddinge; Stockholm Sweden
- Liverpool Health Economics Centre; University of Liverpool; Liverpool UK
- Strathclyde Institute of Pharmacy and Biomedical Sciences; University of Strathclyde; Glasgow UK
| | - Marie Persson
- Unit of Medicine Support; Public Healthcare Services Committee Administration; Stockholm County Council; Stockholm Sweden
| | - Jamilette Miranda
- Department of Healthcare Development; Public Healthcare Services Committee Administration; Stockholm County Council; Stockholm Sweden
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation; Department of Public Health and Community Medicine, Section of Psychiatry; University of Verona; Verona Italy
| | - Marion Bennie
- Strathclyde Institute of Pharmacy and Biomedical Sciences; University of Strathclyde; Glasgow UK
- Information Services Division; NHS National Services Scotland; Edinburgh UK
| | - Alexander E Finlayson
- King's Centre for Global Health; Global Health Offices; Weston Education Centre; London UK
| | - Emanuel Raschi
- Department of Medical and Surgical Sciences; Pharmacology Unit; Alma Mater Studiorum - University of Bologna; Bologna Italy
| | - Bjorn Wettermark
- Department of Laboratory Medicine; Division of Clinical Pharmacology; Karolinska Institute; Karolinska University Hospital Huddinge; Stockholm Sweden
- Department of Healthcare Development; Public Healthcare Services Committee Administration; Stockholm County Council; Stockholm Sweden
- Centre for Pharmacoepidemilogy; Karolinska Institute; Karolinska University Hospital Solna; Stockholm Sweden
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Manchanda R, Chue P, Malla A, Tibbo P, Roy MA, Williams R, Iyer S, Lutgens D, Banks N. Long-acting injectable antipsychotics: evidence of effectiveness and use. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2013; 58:5S-13S. [PMID: 23945067 DOI: 10.1177/088740341305805s02] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To review the evidence for the role of long-acting injectable (LAI) antipsychotics (APs), especially the second-generation AP (SGA) LAIs, in the treatment of schizophrenia and to discuss the use rates of LAIs in Canada. METHOD A search of online medical databases was conducted of the published literature (1995-2012) of the effects of LAIs on the domains of remission, adherence, relapse, and hospitalization. Results obtained from randomized controlled trials (RCTs), systematic reviews, meta-analyses, and large-scale observational studies were included. Expert consensus data were also solicited on LAI use within a Canadian context. RESULTS While the efficacy of LAIs, compared with placebo, is well established, the evidence from RCTs is equivocal for any specific advantage for SGA LAIs, compared with oral medications, probably owing to challenges in conducting such RCTs. Evidence from methodologically less rigorous studies and from clinical practice suggests some advantages in achieving and maintaining remission, risk of relapse, and hospitalization. The rate of LAI (first-generation AP and SGA) use from published outpatient studies is low at 6.3% in Canada, compared with 15% to 80% worldwide. However, there is a relatively high rate of use in specific early psychosis programs and in conjunction with community treatment orders in Canada. CONCLUSIONS LAIs are at least as effective as oral APs in the treatment of psychotic disorders. The former may have specific advantages for patients who demonstrate covert nonadherence. The underuse of LAIs in Canada needs to be better understood and addressed.
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Affiliation(s)
- Rahul Manchanda
- Professor, Department of Psychiatry, Western University, London, Ontario; Director, Prevention and Early Intervention Program for Psychoses, London Health Sciences Centre, London, Ontario.
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Bennie M, Bishop I, Godman B, Barbui C, Raschi E, Campbell S, Miranda J, Gustafsson LL. Are specific initiatives required to enhance prescribing of generic atypical antipsychotics in Scotland?: International implications. Int J Clin Pract 2013; 67:170-80. [PMID: 23305478 DOI: 10.1111/ijcp.12100] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Accepted: 11/28/2012] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND National and regional authorities in Scotland have introduced multiple measures to appreciably enhance prescribing efficiency for the proton pump inhibitors (PPIs), statins and renin-angiotensin inhibitor drugs. Generic oral risperidone recently became available in Scotland; however, schizophrenia is a complex disease with advice from respected authorities suggesting that treatment should be individualised. AIMS To assess (i) changes in atypical antipsychotic drug (AAP) utilisation and expenditure following the availability of oral generic risperidone in Scotland; (ii) to determine (a) current INN prescribing rates for risperidone following generic availability and (b) decrease in expenditure/DDD for generic risperidone; (iii) to suggest additional measures that could possibly be introduced in Scotland to further enhance prescribing of generic AAPs; and (iv) to provide guidance to NHS Scotland as well as other European authorities on the implications. METHODS Retrospective observational study and an interrupted time series design. RESULTS No appreciable change in the utilisation patterns of risperidone pre- and postgeneric availability. Appreciable INN prescribing averaged 93-98% of total oral risperidone. Generic risperidone was 84% below prepatent loss prices by study end, reducing annual expenditure for oral risperidone in 2010 by GB£3.19mn compared with prepatent loss situation. However, overall expenditure on AAPs increased by 42% from 2005 to 2010. DISCUSSION As expected, there was no change in utilisation patterns for risperidone, although potential to influence prescribing patterns. Continued high INN prescribing suggests no problems with generic risperidone in practice. Costs will start to decrease as more AAPs lose their patents (olanzapine and quetiapine). There is the possibility to accelerate this reduction through educational activities. CONCLUSION There is potential to realise some savings with generic AAPs. However, this is limited by the complexity of the disease area. Any measures introduced must aim at increasing the prescribing of generic AAPs first line in suitable patients.
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Affiliation(s)
- M Bennie
- Strathclyde Institute for Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
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