A Cost-effectiveness Analysis of Antipsychotics for Treatment of Schizophrenia in Uganda
Reductions in prices following the expiry of patents on second-generation antipsychotics means that they could be made available to patients with schizophrenia in low-income countries. In this study we examine the cost effectiveness of antipsychotics for schizophrenia in Uganda.
We developed a decision-analytic 10-state Markov model to represent the clinical and treatment course of schizophrenia and the experience of the average patient within the Uganda healthcare system. The model was run for a base population of 25-years-old patients attending Butabika National Referral Mental Hospital, in annual cycles over a lifetime horizon. Parameters were derived from a primary chart abstraction study, a local community pharmacy survey, published literature, and expert opinion where necessary. We computed mean disability-adjusted life-years (DALYs) and costs (in US$ 2012) for each antipsychotic, incremental cost, and DALYs averted as well as incremental cost-effectiveness ratios (ICERs).
In the base-case analysis, mean DALYs were highest with chlorpromazine (27.608), followed by haloperidol (27.563), while olanzapine (27.552) and risperidone had the lowest DALYs (27.557). Expected costs were highest with quetiapine (US$4943), and lowest with risperidone (US$4424). Compared to chlorpromazine, haloperidol was a dominant option (i.e. it was less costly and more effective); and risperidone was dominant over both haloperidol and quetiapine. The ICER comparing olanzapine to risperidone was US$5868 per DALY averted.
When choosing between first-generation antipsychotics, clinicians should consider haloperidol as the first-line agent for schizophrenia. However, overall, risperidone is a cost-saving strategy; policymakers should consider its addition to essential medicines lists for treatment of schizophrenia in Uganda.
KeywordsSchizophrenia Haloperidol Risperidone Olanzapine Quetiapine
Compliance with ethical standards
Solomon J. Lubinga (SJL) received support from the Thomas Francis Junior Global Health Travel Fellowship, 2013 and the Stergachis Endowed Fellowship for International Exchange, 2013 at the University of Washington, Department of Global Health. The research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. SJL, Byama B. Mutamba (BBM), Angelo Nganizi (AN) and Joseph B. Babigumira (JBB) declare no conflict of interest. We obtained approval for the chart abstraction study, health-worker observations and community pharmacy survey from the University of Washington Institutional Review Board, the Institutional Review Committee of Mbarara University of Science and Technology and the Research and Ethics Committee of Butabika National Referral Hospital.
The authors thank the staff of the medical records’ department of Butabika National Referral Mental Hospital for their help in abstracting patient records.
SJL and JBB conceived the study. SJL collected the data, developed the economic model, reviewed the literature, run the analyses and drafted the manuscript. BBM participated in data collection and manuscript revision. AN participated in data collection, literature review and manuscript revision. JBB participated in developing the model and revising the manuscript. SJL is the guarantor of the content of the manuscript. All authors read and approved the final manuscript.
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