Cost-effectiveness analysis of risperdal, quetiapine and olanzapine in treatment of schizophrenia

AIM: To evaluate the economic effectiveness of risperdal, quetiapine and olanzapine in the treatment of patients with schizophrenia. METHODS: Ninety patients with schizophrenia were selected from the Mental Health Center of the First Hospital of Hebei Medical University between April 2003 and May 2005. The patients were randomly divided into risperdal group (n=30), quetiapine group (n=30) and olanzapine group (n=30). Patients in the risperdal group (n=30) orally took the tablets of risperdal 4-8 mg per day, twice a day, those in the quetiapine group orally took the capsules of quetiapine 400-1 000 mg per day, twice a day, and those in the olanzapine group orally took the tablets of olanzapine 10-20 mg per day, twice a day. The average course of treatment was 61.4, 67.5 and 60.1 days respectively. The effectiveness was evaluated with brief psychiatric rating scale (BPRS) before treatment and at 1, 2, 4, 6, 8 and 12 weeks after treatment respectively,, and the BPRS reduction rate was taken as the index to evaluate the effectiveness: ≥ 80% for diminishing of clinical symptoms; 60%-79% as excellent effectiveness; 30%-59% for effectiveness; Less than 30% as no effectiveness. The adverse effect was evaluated with treatment emergent symptom scale (TESS), each symptom was required to be assessed from three regards: severity, relationship between symptom and medication and measures taken. The adverse effects of the drugs were recorded in time. Cost and effectiveness were determined with cost-effectiveness analysis. Cost included the costs of drugs, treatment, examination, hospitalization and time. Effectiveness was based on the total effectiveness, which was the evaluative standard in each therapeutic scheme. Total effective rate=(cases showing the effect+cases having the excellent effect and effect)/total number of cases×100%. Cost-effectiveness was shown by unit effectiveness cost. Cost-effectiveness analysis in amount increase represented the result from the comparison between two different schemes. Calculation was usually made according to the least effectiveness. The article used the olanzapin group e as a basic control. Meanwhile, sensitive degree analysis was made. It was supposed that cost of medications was decreased by 5%, cost of treatment, examination, hospitalization and time was increased by 1% respectively, and total cost would change accordingly. RESULTS: All the 90 cases entered the analysis of results. ① Total effective rate in the risperdal group, quetiapine group and olanzapine group was 96%, 90% and 83% respectively. The total effectiveness had no obvious difference between the risperdal group and quetiapine group, also between the quetiapine group and olanzapine group (P > 0.05), as well as between the risperdal group and olanzapine group (χ2=2.963, P=0.301). ② The daily cost in the risperdal group, quetiapine group and olanzapine group was 222.38, 261.59 and 319.02 yuan respectively, and the total cost was 13 656.36, 17 657.33 and 19 102.67 yuan respectively. ③ The cost in unit effectiveness of the risperdal group, quetiapine group and olanzapine group was 142.45, 196.19 and 230.15 yuan respectively, and it was the smallest in the risperdal group. ④ The daily cost after adjustment in the risperdal group, quetiapine group and olanzapine group was 139.23, 193.71 and 228.85 yaun respectively, and the total cost was adjusted to 13 450.63, 17 455.50 and 19 065.42 yuan respectively. ⑤ Based on the olanzapine group, the unit effectiveness cost in amount increase was smaller in the risperdal group than in the quetiapine group. ⑥ The rate of adverse drug reaction response in risperdai group and ruetiapine group is almost the same, but is less in olanzapine group. CONCLUSION: The unit effectiveness cost is the least in the risperdai group and cost in amount increase is also lower and so is the rate of adverse drug reaction. Therefore, the treatment with risperdai is the best therapeutic scheme.