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Inicio Revista de Psiquiatría y Salud Mental (English Edition) Cost-effectiveness simulation analysis of schizophrenia at the Instituto Mexican...
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Vol. 2. Núm. 3.
Páginas 108-118 (enero 2009)
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Vol. 2. Núm. 3.
Páginas 108-118 (enero 2009)
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Cost-effectiveness simulation analysis of schizophrenia at the Instituto Mexicano del Seguro Social. Assessment of typical and atypical antipsychotics
Análisis de simulación de coste-efectividad en el tratamiento de la esquizofrenia en el Instituto Mexicano del Seguro Social. Evaluación de antipsicóticos típicos y atípicos
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1749
Joaquín Mould-Quevedoa, Iris Contreras-Hernándeza,
Autor para correspondencia
, Wáscar Verduzcob, Juan Manuel Mejía-Aranguréc, Juan Garduño-Espinosaa
a Health economy Research Unit, Mexican Instituto of National Insurance (IMSS), Mexico city, Mexico
b Psychiatric hospital, IMSS, Mexico city, Mexico
c Clinical epidemiology Research Unit, Medical Specialised Hospital, Paediatrics Hospital, Siglo XXI Mexican Medical Centre, IMSS, Mexico city, Mexico
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Abstract
Introduction

Estimation of the economic costs of schizophrenia is a fundamental tool for a better understanding of the magnitude of this health problem. The aim of this study was to estimate the costs and effectiveness of five antipsychotic treatments (ziprasidone, olanzapine, risperidone, haloperidol and clozapine), which are included in the national formulary at the Instituto Mexicano del Seguro Social, through a simulation model.

Methods

Type of economic evaluation: complete economic evaluation of costeffectiveness. Study perspective: direct medical costs. Time horizon: 1 year. Effectiveness measure: number of months free of psychotic symptoms. Analysis: to estimate costeffectiveness, a Markov model was constructed and a Monte Carlo simulation was carried out.

Results

Effectiveness: the results of the Markov model showed that the antipsychotic with the highest number months free of psychotic symptoms was ziprasidone (mean 9.2 months). The median annual costs for patients using ziprasidone included in the hypothetical cohort was 194,766.6 Mexican pesos (MXP) (95% CI, 26,515.6-363,017.6 MXP), with an exchange rate of 1 €=17.36 MXP. The highest costs in the probabilistic analysis were estimated for clozapine treatment (260,236.9 MXP).

Conclusions

Through a probabilistic analysis, ziprasidone showed the lowest costs and the highest number of months free of psychotic symptoms and was also the most costeffective antipsychotic observed in acceptability curves and net monetary benefits.

Keywords:
Schizophrenia
Cost-effectiveness analysis
Antipsychotics
Atypical antipsychotics
Typical psychotics
Resumen
Introducción

La estimación de los costes económicos de la esquizofrenia constituye un aspecto fundamental para el mejor conocimiento de la magnitud del problema de salud. En este sentido, el presente trabajo de investigación tiene como propósito estimar a través de un estudio de simulación los costes y las efectividades de cinco tratamientos antipsicóticos (ziprasidona, olanzapina, risperidona, haloperidol y clozapina) que se encuentran dentro del cuadro básico del Instituto Mexicano del Seguro Social (IMSS).

Métodos

Tipo de evaluación económica: completa del tipo de coste-efectividad. Perspectiva de la investigación: costes médicos directos. La temporalidad del estudio fue de 1 año. Medida de efectividad: número de meses libres de síntomas psicóticos. Análisis: para el análisis de coste-efectividad se diseñó un modelo de Markov y se hizo una simulación de Monte Carlo.

Resultados

Efectividades: los resultados del modelo de Markov mostraron que la ziprasidona fue el antipsicótico con la mayor media de tiempo libre de síntomas psicóticos (9,2 meses). La mediana de costes anuales entre los pacientes simulados a través de la cohorte hipotética con ziprasidona resultó en 194.766,6 (intervalo de confianza del 95%, 26.515,6-363.017,6) pesos mexicanos (PMX) (tipo de cambio, 1 euro=17,36 PMX). Los mayores costes en el análisis probabilístico se presentaron con el tratamiento con clozapina (260.236,9 PMX).

Conclusiones

Dentro de un análisis probabilístico, ziprasidona mostró los menores costes y el mayor número de meses libres de síntomas psicóticos, así como ser el antipsicótico más coste-efectivo según lo observado dentro de las curvas de aceptabilidad y de beneficios monetarios netos.

Palabras clave:
Esquizofrenia
Análisis de coste-efectividad
Antipsicóticos
Antipsicóticos típicos
Antipsicóticos atípicos
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