RESUMEN
Since clozapine has been introduced into the treatment of schizophrenia, pharmaceutical costs rised in hospital. However, this data is not sufficient to estimate its global effect on cost-effectiveness; that's why we studied the whole direct costs generated by schizophrenia, the clinical effectiveness as well as the impact of therapeutics on the patients' quality of life. This work is a retrospective study of cost-effectiveness of clozapine treatment within three french psychiatric hospitals. The study was divided into three parts: - a twelve-month period concerning the treatment before clozapine; - two twelve-month periods for the analysis of clozapine treatment. The clinical evaluation was based on the CGI and an autoevaluation scale. Whether schizophrenic patients were hospitalized or not and the importance of neuroleptic-associated medicines were taken into account to evaluate the Quality of Life. The economical assessment is represented by adding pharmaceutical costs, biological examinations costs and hospitalization costs. Thirty-seven patients, out of seventy-five, were being taken into account (26 men and 11 women). The results of the CGI and autoevaluation scale showed a global improvement in the pathology within the first year of treatment, which is confirmed during the second year. A statistically significant decrease in the length of full-time hospitalization was noticed; this profits to half-time hospitalization, indeed purely ambulatory. The direct costs per patient and per day insignificantly decreased between the first and the second period; on the other hand, the drop was statistically significant between the second and the third period. This study, based on a small amount of patients shows that the use of clozapine, which clearly helped the patients to improve, leads to a drop in global direct costs per patient, despite the high cost of the medicine itself, as well as an improvement in the quality of life.
Asunto(s)
Antipsicóticos/economía , Clozapina/economía , Esquizofrenia/tratamiento farmacológico , Psicología del Esquizofrénico , Adulto , Antipsicóticos/efectos adversos , Antipsicóticos/uso terapéutico , Clozapina/efectos adversos , Clozapina/uso terapéutico , Análisis Costo-Beneficio , Femenino , Humanos , Masculino , Persona de Mediana Edad , Readmisión del Paciente/economía , Satisfacción del Paciente , Escalas de Valoración Psiquiátrica , Estudios Retrospectivos , Esquizofrenia/economíaRESUMEN
1. Plasma levels were monitored for about 18 months during therapy with haloperidol decanoate. When steady-state was reached, patients treated without enzyme inducers showed in their plasma concentrations a stable plateau and a very low fluctuation. Furthermore, doses were correlated to plasma levels (r = 0.9). 2. Contrary, patients treated with both haloperidol decanoate and enzyme inducers seemed to present in their plasma concentration a very large fluctuation with C min (plasma concentrations measured just before the injection) significantly lower than those of the other group. Moreover their C min values were excluded from the linear regression curve calculated between plasma levels and doses in patients without enzyme inducers. 3. Our data suggest a shortening of the absorption half-time of haloperidol. In this case, it seems necessary to diminish the interval between injections than to give higher dosage in order to maintain plasma concentrations.