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>
Neurologically impaired children and digestive problems
Child; Humans; Follow-Up Studies; Prospective Studies; Treatment Outcome; Fundoplication; Enteral Nutrition; adolescent; Preschool; infant; Q3 Literature Search; Injections; disabled children; Botulinum Toxin Type A/administration & dosage; Brain Damage; Chronic/complications/therapy; France; Gastric Acidity Determination; Gastroesophageal Reflux/complications/therapy; Gastroscopy; Intramuscular; Protein-Energy Malnutrition/etiology/therapy
2006
Podevin G; Capito C; Leclair MD; Heloury Y
Archives De Pediatrie
2006
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/10.1016/j.arcped.2006.03.041" target="_blank" rel="noreferrer">10.1016/j.arcped.2006.03.041</a>
Pharmacokinetic optimisation of opioid treatment in acute pain therapy
Humans; Pain; Analgesics; Drug Interactions; Analgesia; Drug Administration Schedule; Administration; Oral; Pain/drug therapy; Infusions; Injections; Intravenous; Dose-Response Relationship; Drug; Subcutaneous; Intramuscular; Patient-Controlled; Postoperative/drug therapy; Substance-Related Disorders; Opioid/pharmacokinetics/pharmacology/therapeutic use; Central Nervous System/drug effects/metabolism
Traditionally, opioids have been administered as fixed doses at fixed dose intervals. This approach has been largely ineffective. Patient-controlled analgesia (PCA) and upgraded traditional approaches incorporating flexibility in dose size and dose interval, and titration for an effect in individual patients with the monitoring of pain and sedation scores, can greatly improve the efficacy of opioid administration. Optimising opioid use, therefore, entails optimising the titration process. Opioids have similar pharmacodynamic properties but have widely different kinetic properties. The most important of these is the delay between the blood concentrations of an opioid and its analgesic or other effects, which probably relate to the delay required for blood and brain and spinal cord (CNS) equilibrium. The half-lives of these delays range from approximately 34 minutes for morphine to 1 minute for alfentanil. The titration is influenced by the time needed after an initial dose before it is safe to administer a second dose and the duration of the effects of a single dose, which varies widely between opioids, doses and routes of administration. To compare opioids and routes of administration, we examined the relative CNS concentration profiles of opioids - the CNS concentration expressed as a percentage of its maximum value. The relative onset was the defined as the time the relative CNS concentration first rose to 80% of maximum, while the relative duration was defined as the length of time the concentration was above 80%. For an intravenous bolus dose, the relative onset varies from approximately 1 for alfentanil to 6 minutes for morphine, while their relative durations are approximately 2 and 96 minutes, respectively. Although all of the common opioids, perhaps with the exception of alfentanil, have kinetic and dynamic properties suitable for use in PCA with intravenous bolus doses, the long relative duration of morphine makes it particularly suited to an upgraded traditional approach using staff administered intramuscular or subcutaneous doses. There is a clear kinetic preference for regimens with a rapid onset and short duration (e.g. intravenous PCA) for coping with incident pain. It is shown that, in general, titration is improved by the more frequent administration of smaller doses, but it is important to use additional doses to initially 'load' a patient. The titration of opioids should always be accompanied by the monitoring of pain and sedation scores and ventilation.
1997
Upton RN; Semple TJ; Macintyre PE
Clinical Pharmacokinetics
1997
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/10.2165/00003088-199733030-00005" target="_blank" rel="noreferrer">10.2165/00003088-199733030-00005</a>