Cost-utility analysis of olanzapine versus combination of haloperidol-diazepam in patients with acute phase schizophrenia: An Indonesian context

Hesty Utami Ramadaniati; Yusi Anggriani; Fredrick Dermawan Purba; Desweri Muhareni

Abstract

This study aimed to estimate the cost per quality-adjusted life-year (QALY) of olanzapine versus the combination of haloperidol-diazepam in acute phase schizophrenia. An observational study was conducted in a psychiatric hospital in Indonesia involving acute phase schizophrenic patients receiving either olanzapine or combination of haloperidol and diazepam. The outcome measures included Positive and Negative Syndrome Scale (PANSS) score, length of stay in acute room, utility score, and QALY. PANSS score and utility score were rated by psychiatrists and nurses, respectively, at the initiation of study medicines and after patient stabilization (postintervention). Calculated costs were direct medical costs with third-party payer perspective. QALY was determined by multiplying the utility score by the duration of the treatment effect to provide the number of QALY gained. A total of 193 patients (102 in olanzapine group/OG vs. 91 in haloperidol-diazepam group/HG). Postintervention, PANSS score significantly decreased by 16.09 in OG and 14.64 in HG. Patients in the two groups spent similar amount of time in acute room (i.e., 3–6 days). Both groups showed no significant difference in utility score and QALY post-treatment. Olanzapine incurred higher costs (US 20.89/QALY) than the comparator ($US 18.10/QALY). In conclusion, the combination of haloperidol-diazepam was a cost-effective option for treating acute phase schizophrenia.

Keyword: Cost utility quality of life haloperidol olanzapine schizophrenia.

Citation:

Ramadaniati HU, Anggriani Y, Purba FD, Muhareni D. Cost-utility analysis of olanzapine versus combination of haloperidol-diazepam in patients with acute phase schizophrenia: An Indonesian context. J Appl Pharm Sci, 2022. Online First.

Copyright: © The Author(s). This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Reference

Badan Penyelenggara Jaminan Sosial-Kesehatan [Indonesian Social Security Agency for Health]. Penderita skizofrenia bisa mendapat pelayanan Kesehatan melalui JKN-KIS [Patients with Schizophrenia can Access Healthcare Provison through National Insurance], 2017. Available via https://bpjs-kesehatan.go.id (Accessed 27 March 2020).

Badan Penyelenggara Jaminan Sosial-Kesehatan [Indonesian Social Security Agency for Health]. Gangguan Kejiwaan Dijamin BPJS Kesehatan, 2022. Available via https://bpjs-kesehatan.go.id/bpjs/post/ read/2022/2161/Gangguan-Kejiwaan-Dijamin-BPJS-Kesehatan (Accessed 28 February 2022).

Beasley CM, Sutton VK, Hamilton SH, Walker DJ, Dossenbach M, Taylor CC, Alaka KJ, Bykowski D, Tollefson GD. A double-blind, randomized, placebo-controlled trial of olanzapine in the prevention of psychotic relapse. J Clin Psychopharmacol, 2003; 23:582-94. https://doi.org/10.1097/01.jcp.0000095348.32154.ec

Bhana N, Foster RH, Olney R, Plosker GL. Olanzapine: an updated review of its use in the management of schizophrenia. Drugs, 2001; 61:111-61. https://doi.org/10.2165/00003495-200161010-00011

Chong HY, Teoh SL, Wu DB, Kotirum S, Chiou CF, Chaiyakunapruk N. Global economic burden of schizophrenia: a systematic review. Neuropsychiatr Dis Treat, 2016; 12:357-73. https://doi.org/10.2147/NDT.S96649

Gomez JC, Sacristan JA, Hernandez J, Breier A, Ruiz-Carrasco P, Anton-Saiz C, Fontova-Carbonell E. The safety of olanzapine compared with other antipsychotic drugs: results of an observational prospective study in patients with schizophrenia (EFESO Study). Pharmacoepidemiologic Study of Olanzapine in Schizophrenia. J Clin Psychiatry, 2000; 61:335-43. https://doi.org/10.4088/JCP.v61n0503

Grunder G, Heize M, Cordes J, Muhlbauer B, Juckel G, Schulz C, Ruther E, Timm J. Effects of first-generation antipsychotics versus second-generation antipsychotics on quality of life in schizophrenia: a double-blind, randomised study. Lancet Psychiatry, 2016; 3:717-29. https://doi.org/10.1016/S2215-0366(16)00085-7

Hamilton SH, Revicki DA, Edgell ET, Genduso LA, Tollefson G. Clinical and economic outcomes of olanzapine compared with haloperidol for schizophrenia. Results from a randomised clinical trial. Pharmacoeconomics, 1999; 15:469-80. https://doi.org/10.2165/00019053-199915050-00005

Hayhurst KP, Massie JA, Dunn G, Lewis SW, Drake RJ. Validity of subjective versus objective quality of life assessment in people with schizophrenia. BMC Psychiatry, 2014; 14:365. https://doi.org/10.1186/s12888-014-0365-x

Indonesian Ministry of Health. Report of Basic Health Research, 2018. Available via http://labmandat.litbang.depkes.go.id/images/ download/laporan/RKD/2018/Laporan_Nasional_RKD2018_FINAL.pdf (Accessed 1 April 2020).

Institution of Health Metrics and Evaluation. Global health data exchange, 2019. Available via http://ghdx.healthdata.org/gbd-resultstool?params=gbd-api-2019-permalink/27a7644e8ad28e739382d31e77589 dd7 (Accessed 25 September 2021).

Jin H, Mosweu I. The societal cost of schizophrenia: a systematic review. Pharmacoeconomics, 2017; 35:25-42. https://doi.org/10.1007/s40273-016-0444-6

Kementerian Kesehatan Republik Indonesia [Indonesian Ministry of Health]. Pedoman Nasional Pelayanan Kedokteran Jiwa [National Guideline on Psychiatric Disease Management]. Kementerian Kesehatan Republik Indonesia, [Indonesian Ministry of Health], Jakarta, Indonesia, 2015.

Krejcie RV, Morgan DW. Determining sample size for research activities. Educ Psychol Measure, 1970; 30:607-10. https://doi.org/10.1177/001316447003000308

Leucht S, Corves C, Arbter D, Engel RR, Li C, Davis JM. Secondgeneration versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis. Lancet, 2009; 373:31-41. https://doi.org/10.1016/S0140-6736(08)61764-X

Montoya A, Valladares A, Lizan L, San L, Escobar R, Paz S. Validation of the Excited Component of the Positive and Negative Syndrome Scale (PANSS-EC) in a naturalistic sample of 278 patients with acute psychosis and agitation in a psychiatric emergency room. Health Qual Life Outcomes, 2011; 9:18. https://doi.org/10.1186/1477-7525-9-18

Muhareni D, Aanggriani Y, Purba FD. Analisis Efektivitas Biaya Terapi Olanzapin dan Kombinasi Haloperidol dengan Diazepam secara Intramuskular pada Pasien Rawat Inap Skizofrenia Fase Akut di RSKD Duren Sawit [Cost effective Analysis of Intramuscular Olanzapine and Combination of Intramuscular Haloperidol with Diazepam in Acute Phase Schizophrenia Inpatients in Duren Sawit Psychiatric Hospital]. Majalah Farmasi dan Farmakologi, 2021; 25:28-31.

National Institute for Health and Care Excellence. Psychosis and schizophrenia in adults: prevention and management, 2014. Available via https://www.nice.org.uk/guidance/cg178/resources/ psychosis-and-schizophrenia-in-adults-prevention-and-managementpdf-35109758952133 (Accessed 16 July 2019).

Pinem VE. Perbandingan Olanzapin Intramuskular dan Haloperidol Intramuskular dalam penanganan Agitasi pada Pasien Skizofrenik [Comparison of Intramuscular Olanzapin and Intramuscular Haloperidol In Management of Agitation in Schizophrenia]. Postgraduate Thesis, University of North Sumatra, 2010.

Purba FD, Hunfeld JAM, Iskandarsyah A, Fitriana TS, Sadarjoen SS, Ramos-Goni JM, Passchier J, Busschbach JJV. The Indonesian EQ-5D5L Value Set. PharmacoEconomics, 2017; 35:1153-65. https://doi.org/10.1007/s40273-017-0538-9

Rascati KL. Essentials of pharmacoeconomics. Lippincott Williams & Wilkins, Philadelphia, PA, 2009. Remington G, Addington D, Honer W, Ismail Z, Raedler T, Teehan M. Guidelines for the pharmacotherapy of schizophrenia in adults. Can J Psychiatr, 2017; 62:604-16. https://doi.org/10.1177/0706743717720448

Ringen PA, Engh JA, Birkenaes AB, Dieset I, Andreassen OA. Increased mortality in schizophrenia due to cardiovascular disease-a nonsystematic review of epidemiology, possible causes, and interventions. Front Psychiatr, 2014; 5:137. https://doi.org/10.3389/fpsyt.2014.00137

Rosenheck R, Perlick D, Bingham S, Liu-Mares W, Collins J, Warren S, Leslie D, Allan E, Campbell EC, Caroff S, Corwin J, Davis L, Douyon R, Dunn L, Evans D, Frecska E, Grabowski J, Graeber D, Herz L, Kwon K, Lawson W, Mena F, Sheikh J, Smelson D, Smith-Gamble V. Effectiveness and Cost of Olanzapine and Haloperidol in the Treatment of Schizophrenia: a randomized controlled trial. JAMA, 2003; 290:2693-702. https://doi.org/10.1001/jama.290.20.2693

Sacristan JA, Gomez JC, Montejo AL, Vieta E, Gregor KJ. Doses of olanzapine, risperidone, and haloperidol used in clinical practice: results of a prospective pharmacoepidemiologic study. EFESO Study Group. Estudio Farmacoepidemiologico en la Esquizofrenia con Olanzapina. Clin Ther, 2000; 22:583-99. https://doi.org/10.1016/S0149-2918(00)80046-6

The American Psychiatric Association. Practice guideline for the treatment of patients with schizophrenia, 2020. Available via https:// psychiatryonline.org/doi/book/10.1176/appi.books.9780890424841. https://doi.org/10.1176/appi.books.9780890424841

Tollefson GD, Beasley CM, Tran PV, Street JS, Krueger JA, Tamura RN, Graffeo KA, Thieme ME. Olanzapine versus haloperidol in the treatment of schizophrenia and schizoaffective and schizophreniform disorders: results of an international collaborative trial. Am J Psychiatry, 1997; 154:457-65. https://doi.org/10.1176/ajp.154.4.457

Tunis SL, Johnstone BM, Gibson PJ, Loosbrock DL, Dulisse BK. Changes in perceived health and functioning as a cost-effectiveness measure for olanzapine versus haloperidol treatment of schizophrenia. J Clin Psychiatry, 1999; 60(Suppl 19):38-45; discussion 46.

Ucok A, Gaebel W. Side effects of atypical antipsychotics: a brief overview. World Psychiatr, 7:58-62. https://doi.org/10.1002/j.2051-5545.2008.tb00154.x

Vos T, Barber R, Bell B, Bertozzi-Villa A, Biryukov S, Bolliger I, Charlson F, Davis A, Degenhards L, Dicker D, Duan L, Erskine H, Feigin V, Ferrari A, Fitzmaurice C, Fleming T, Graetz N, Guinovart C, Haagsma J, Yadav A. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet, 2015; 386:743-800. https://doi.org/10.1016/S0140-6736(15)60692-4

Wei Xin Chong J, Hsien-Jie ET, Chong CE, Ny Y, Wijesinghe R. Atypical antipsychotics: a review on the prevalence, monitoring, and management of their metabolic and cardiovascular side effects. Ment Health Clin, 2016; 6:178-84. https://doi.org/10.9740/mhc.2016.07.178

World Health Organization. Mental disorders, 2018. Available via https://www.who.int/news-room/fact-sheets/detail/mental-disorders (Accessed 29 June 2020).

Zhang G, Sackman RW. The role of serotonin 5-HT2A receptors in memory and cognition. Front Pharmacol, 2015; 6:225. https://doi.org/10.3389/fphar.2015.00225

Abstract

HTML Full Text

Reference

Article Metrics

Related Search

Citiaion Alert By Google Scholar

Similar Articles