8 INT-ERNATIONAL RESEARCH & OPINION

Mental health news from ISPOR Philadelphia, US May 1998

There has been tremendous growth in the field of pharmacoeconomics and outcomes research in mental health, said Dr Peter Neumann from the Harvard School of Public Health, Boston, US, at the Third Annual International Meeting of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) [Philadelphia, US; May 1998]. At the meeting, several sessions were devoted to presentations of studies on the economics and outcomes of mental health and its treatment; results of a selection of these presentations are outlined below.

AD spending estimated at $US200 million Spending by Medicaid in California, US, for patients

with Alzheimer's disease (AD) may be as high as $US200 million/year, or 10% of all expenditures for elderly Medicaid enrollees, based on the results of a prevalence-based cost-of-illness study* presented by Dr Joseph Menzin, president of Boston Health Economics, Inc., Massachusetts, US .1

According to Dr Menzin, the limited data on the costs of AD make it difficult to establish priorities for budgeting healthcare services for this condition. It also hinders the establishment of a baseline against which to measure interventions. Although there are 2-4 million people in the US with AD, there is no available information regarding the costs of AD to healthcare payers.

The study was based on 1995 claims data for a 10% random sample of Medi-Cal recipients aged ~ 60 years who were not enrolled in health maintenance organi­sation plans (n = 62450). 2575 (4.1 %) of this popu­lation were identified as having AD and/or dementias. 2575 enrollees from the remaining comparison cohort were randomly selected as matched controls.

Compared with the control group, several comorbid conditions were more common, and the use of health­care resources was higher, among enrollees with AD and/or dementias [see table]. Furthermore, the mean number of days of institutional care was 100 days higher in the AD group compared with the non-AD group.

C b'd'ty d omor 1 1 an use 0 fh lth ea care resources among Medi-Cal enrollees with AD and/or dementias

Enrol"" with Enrol .... without ADldementlas (%) ADidementias (%)

Comofbld conditions:

Cardiovascular diseases 21 .4 12.2

Psychiatric conditions 14.8 4.6

Degenerative eNS' 7.0 1.9

Selected infections 19.8 10.1

Healthcent resource use:

Inpatient hospitalisation 14.1 9.7

Nursing-home care 65.2 23.9

• central nervous system

After adjustment, the average annual payment per enrollee with AD and/or dementias was SUS 14 488

PharmacoEconomics & Outcomes News 27 Jun 19118 No. 168

compared with $US6799 for those without AD and/or dementias (p < 0.01). 90% of this cost difference was associated with the use of nursing-home care.

Olanzapine reduces per-patient costs Use of the atypical antipsychotic olanzapine reduced

per-patient medical costs from SUS 17 900 to SUS9600 among patients with schizophrenia at the Den ver Veterans Affairs Medical Center, Colorado, US.2

These are the fmdings of a study that assessed the costs associated with antipsychotic prescriptions, mental health clinic visits and hospital stays during the six months before and after initiation of olanzapine therapy.

Of 59 olanzapine recipients identified from pharmacy databases, 25 had received the drug for ~ 6 months.

Six months after starting olanzapine therapy (about 30 mg/day), the mean number of hospital admissions decreased from 1.08 to 0.48 per patient and the average duration of hospital stay decreased from 27.9 to 8.4 days; this reduced total hospitalisation costs from $US301 100 to $US90 700. The mean number of mental health clinic visits decreased from 112 to 79 visits, which reduced total costs for this intervention from $US131 100 to $US93 100. Although the mean number of antipsychotic prescriptions increased only slightly from 3.4 to 3.5 per patient, the cost of these prescriptions rose from $US586 to $US2230 per patient or from a total of SUS 14700 to $US55 800.

However, the increase in pharmacy costs associated with the use of olanzapine was not high enough to offset reductions in the costs of other heaJthcare services.

Venlafaxine vs TeAs after switching fromSSRIs

The higher acquisition cost associated with the use of venlafaxine as second-line therapy for depression is offset by lower professional and facility costs, compared with tricyclic or tetracyclic antidepressants (TCAs).3

This is the finding of a US study that used claims data from a managed-care organisation to identify patients with depression who were switched from a selective serotonin reuptake inhibitor (SSRI) to either venlafaxine (n = 188) or a TCA (172) between 1993 and 1997. The study authors noted that among SSRI recipients, 20-50% of patients may be resistant or achieve only partial responses to such therapies.

Median total costs per-patient after I year of treatment were $US3356 and $US4661 for venlafaxine and TCA recipients, respectively. Although the median acquisition cost was higher for venlafaxine ($US661 ) than for TCAs ($US 158), this was offset by lower facility costs ($US159 and $US527, respectively) and lower professional costs ($US1410 and $US2016) with venlafaxine.

The total per-patient cost of treatment at 1 year remained $US313 lower for venlafaxine after adjusting for patient age and gender, prescriber, medication

* The study was sponsored by Pfizer.

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INTERNATIONAL RESEARCH & OPINION

possession ratio, health plan and 6-month prior comorbidity costs.

Sertindole VS olanzapine or haloperidol Sertindole is cost saving and associated with greater

effectiveness compared with olanzapine or haloperidol for patients with schizophrenia, according to a pharmacoeconcm:c mcde!!ing study conducted by European researchers.4

Because the economic impact of new antipsychotics in naturalistic settings is still unknown, the researchers evaluated the cost and effectiveness of sertindole and olanzapine, compared with haloperidol, in usual practice using a Markov model. The 6-month cycle decision tree initially branched into the 3 drug regimens, followed by further subdivisions into the various care structures (i.e. patient residence and intensity of care), the clinical events (i.e. frequency of relapse, adverse drug reactions, toxicity and compliance) and the patients' paths in the healthcare system.

In patients with schizophrenia, sertindole was associated with additional time without relapse of 5 and 13.5 months compared with olanzapine and haloperidol, respectively. Compared with sertindole, the relative risks of relapse associated with olanzapine or haloperidol were 1.2 and 1.4, respectively. Sertindole reduced the cost of hospitalisation by $US6500 com­pared with olanzapine and by $US 12000 compared with haloperidol to generate a 'slight' net saving when the acquisition cost of the drug was considered.

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Buprenorphine improves QOt in opioid dependence

There were improvcmcnts in several dimensions of the Short Form-36 Health Survey (SF-36) following use of buprenorphine for 100 patients with opioid dependence who were enrolled in a US study.s

Patients received either the liquid or tablet form of buprenorphine, and dosage levels of the drug varied monthly. Patients completed the SF-36 at baseline and monthly throughout the l6-week study. 44 patients provided complete data throughout the entire study period.

Upon completion of the study, patients reported significant improvements in the quality-of-life (QOL) dimensions for bodily pain, general health, mental health, social function and vitality. In contrast, buprenorphine therapy did not improve the physical function, role physical and role emotional dimensions of the SF-36.

1. Menzin J. et aI. The economic burden of Alzheimer's disease to Medicaid in California. Value in Health 1: 25, May-Jun 19982. Weiss MA, et aI. Cost impact of using olanzapine at a Veterans Affairs medical center. Value in Health I: 25, May·Jun 19983. Griffiths R1, et aI . Medical costs of venlafaxine versus tricyclic or tetracyclic antidepressant therapy after switching from selective serotonin reuptake inhibitors. Value in Health I: 30, May-Jun 1998 4. Launois R, et aI. Cost-effectiveness evaluation of new antipsychotics. Value in Health I: 30-31 , May-Jun 1998 S. Raisch DW, et aI. Assessment of health-related quality of life during treatment of opiate dependence using the Short Form-36. Value in Health I: 78, May-Jun 1998 1I00I'2100

PharmacoEconomics & Oulcomes News 27 Jun 1998 No. 168

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