Cost-effectiveness analysis of ziprasidone versus haloperidol in sequential intramuscular/oral treatment of exacerbation of schizophrenia: economic subanalysis of the ZIMO trial.
Female; Humans; Male; Adult; Treatment Outcome; Drug Therapy; Research Design; Cost-Benefit Analysis; Cost of Illness; Spain; quality of life; Administration; Oral; IM; Injections; Intramuscular; Drug Costs; Haloperidol/ad [Administration & Dosage]; Combination; Hospital Costs; Antipsychotic Agents/ad [Administration & Dosage]; Antipsychotic Agents/ec [Economics]; Brief Psychiatric Rating Scale; Haloperidol/ec [Economics]; Length of Stay/ec [Economics]; Piperazines/ad [Administration & Dosage]; Piperazines/ec [Economics]; Schizophrenia/dt [Drug Therapy]; Schizophrenia/ec [Economics]; Thiazoles/ad [Administration & Dosage]; Thiazoles/ec [Economics]
OBJECTIVE: This study aimed to assess the cost effectiveness of ziprasidone versus haloperidol in sequential intramuscular (IM)/oral treatment of patients with exacerbation of schizophrenia in Spain. METHODS: A cost-effectiveness analysis from the hospital perspective was performed. Length of stay, study medication and use of concomitant drugs were calculated using data from the ZIMO trial. The effectiveness of treatment was determined by the percentage of responders (reduction in baseline Brief Psychiatric Rating Scale [BPRS] negative symptoms subscale >or=30%). Economic assessment included estimation of mean (95% CI) total costs, cost per responder and the incremental cost-effectiveness ratio (ICER) per additional responder. The economic uncertainty level was controlled by resampling and calculation of cost-effectiveness acceptability curves. RESULTS: A total of 325 patients (ziprasidone n = 255, haloperidol n = 70) were included in this economic subanalysis. Ziprasidone showed a significantly higher responder rate compared with haloperidol (71% vs 56%, respectively; p = 0.023). Mean total costs were euro3582 (95% CI 3226, 3937) for ziprasidone and euro2953 (95% CI 2471, 3436) for haloperidol (p = 0.039), mainly due to a higher ziprasidone acquisition cost. However, costs per responder were lower with ziprasidone (euro5045 [95% CI 4211, 6020]) than with haloperidol (euro5302 [95% CI 3666, 7791], with a cost per additional responder (ICER) for ziprasidone of euro4095 (95% CI -130, 22 231). The acceptability curve showed an ICER cut-off value of euro13 891 at the 95% cost-effectiveness probability level for >or=30% reduction in BPRS negative symptoms. CONCLUSIONS: Compared with haloperidol, ziprasidone was significantly better at controlling psychotic negative symptoms in acute psychoses. The extra cost of ziprasidone was offset by a higher effectiveness rate, yielding a lower cost per responder. In light of the social benefit (less family burden and greater restoration of productivity), the incremental cost per additional responder with sequential IM/oral ziprasidone should be considered cost effective in patients with exacerbation of schizophrenia in Spain.
2007
Canas F; Perez-Sola V; Diaz S; Rejas J; ZIMO Trial Collaborative Group
Clinical Drug Investigation
2007
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.2165/00044011-200727090-00005" target="_blank" rel="noreferrer">10.2165/00044011-200727090-00005</a>
A D2 antagonist enhances the rewarding and priming effects of a gambling episode in pathological gamblers.
Female; Humans; Male; Pain Measurement; Adult; Middle Aged; Semantics; Analysis of Variance; Motivation; Double-Blind Method; IM; Psychiatric Status Rating Scales; Neuropsychological Tests; Blood Pressure/de [Drug Effects]; Dopamine Antagonists/ad [Administration & Dosage]; Dopamine Antagonists/ae [Adverse Effects]; Gambling/px [Psychology]; Haloperidol/ad [Administration & Dosage]; Haloperidol/ae [Adverse Effects]; Reaction Time/de [Drug Effects]; Reward
Previous research indicated shared neurochemical substrates for gambling and psychostimulant reward. This suggests that dopamine substrates may directly govern the reinforcement process in pathological gambling. To investigate this issue, the present study assessed the effects of the relatively selective dopamine D2 antagonist, haloperidol (3 mg, oral) on responses to actual gambling (15 min on a slot machine) in 20 non-comorbid pathological gamblers and 18 non-gambler controls in a placebo-controlled, double-blind, counterbalanced design. In gamblers, haloperidol significantly increased self-reported rewarding effects of gambling, post-game priming of desire to gamble, facilitation of reading speed to Gambling words, and gambling-induced elevation in blood pressure. In controls, haloperidol augmented gambling-induced elevation in blood pressure, but had no effect on other indices. The findings provide direct experimental evidence that the D2 substrate modulates gambling reinforcement in pathological gamblers.
2007
Zack M; Poulos CX
Neuropsychopharmacology
2007
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1038/sj.npp.1301295" target="_blank" rel="noreferrer">10.1038/sj.npp.1301295</a>