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Estudio de costo-efectividad del tratamiento de la esquizofrenia en México
| Content Provider | Semantic Scholar |
|---|---|
| Author | Lara-Muñoz, María Del Carmen Robles-Garcia, Rebeca Orozco, Ricardo Méndez, María Teresa Saltijeral Medina-Mora, María Elena Chisholm, Dan |
| Copyright Year | 2010 |
| Abstract | SUMMARYIntroductionSchizophrenia is a disorder that causes significant disability. Inaddition, its treatment is expensive because the increased prescriptionof atypical antipsychotics with associated high costs.In a recent 14- country study on disability associated with physicaland mental conditions, active psychosis was ranked the third mostdisabling condition in general population, more than paraplegia andblindness. In the global burden of disease study, schizophreniaaccounted for 1.1% of the total Disability-adjusted life years (DALYs)and 2.8% of Years of lived with disability (YLDs). The economic costof schizophrenia for society is also high.The study of the burden of schizophrenia for society, whetherexpressed in epidemiological or costs terms, is an insufficient basisfor setting priorities for resources allocation. Thus, increasinglysophisticated economic models have been developed.Such is the case of cost-effectiveness studies, which show therelationship between resources used (costs) and benefit achieved(effectiveness) of an intervention compared with others.In Mexico, there is only one study that evaluated the cost-effectiveness of different antipsychotics to treat schizophrenia, but itwas a specific approach (not generalized), and did not includepsychological interventions.The present study is part of a World Health Organization'sinitiative labeled WHO-CHOICE: CHOosing Interventions that areCost-Effective. WHO-CHOICE methodology involves the evaluationof interventions based on a generalized measure: DALYs, which allowscarrying out several and important comparisons.The main objective was to determine the cost-effectiveness ofdifferent interventions for the treatment of schizophrenia in Mexicancommunitarian settings.MethodSchizophrenia was modeled as a serious chronic disorder with a highlevel of disability, excess mortality from natural and unnatural causes,and a low rate of remission. The incidence, prevalence, and the fatalityrate were estimated based on the study of the Global Burden ofDisease and a review of the epidemiological literature.As the first episode of schizophrenia is currently not preventable,the occurrence represents how the epidemiological situation wouldbe without intervention. In relation to the referral and the fatality, wedid not found evidence that these rates change by a specific effect ofthe treatment; thus, they were kept as constants for the scenarios withor without treatment.Community-level interventions assessed were: 1. typicaltraditional antipsychotics (haloperidol), 2. new atypical antipsychotics(risperidone), 3. traditional antipsychotics + psychosocial treatment(family therapy, social skills training and cognitive behavioral therapy),4. new antipsychotics + psychosocial treatment, 5. traditionalantipsychotics + psychosocial treatment + case management, and6. new antipsychotics + psychosocial treatment + case management.The effectiveness of the treatments referred to the control ofpositive and negative symptoms and associated levels of disability. Tocalculate the improvement in disability compared with natural history(when the disease is not treated), the effect sizes reported in controlledclinical trials were converted to a weight change of disability. Efficacyand extrapyramidal effects of typical and atypical antipsychoticscompared to placebo were estimated from the meta-analysis ofcontrolled clinical trials, with the score of the BPRS severity scale andthe need anti-Parkinson drugs as efficacy measures. From anothermeta-analysis we obtained an estimate of the magnitude of the effectby adding psychosocial interventions. As an ad hoc Cochranesystematic review that found case management did not had asignificant impact on clinical or psychosocial outcomes, only a minimaladdition effect size when added to the combination of pharmacologic-psychosocial treatment was observed.Costs included those of the patient, the program and the trainingrequired to implement the intervention. The provision of community-based services, daily administration of antipsychotics andanticholinergics, and laboratory tests were taken into account. Forpsychological interventions were envisaged from 6 to 12 sessions: in |
| Starting Page | 211 |
| Ending Page | 218 |
| Page Count | 8 |
| File Format | PDF HTM / HTML |
| Volume Number | 33 |
| Alternate Webpage(s) | http://sid.usal.es/idocs/F8/ART15495/estudio_del_costo_efectividad.pdf |
| Alternate Webpage(s) | http://www.scielo.org.mx/pdf/sm/v33n3/v33n3a1.pdf |
| Alternate Webpage(s) | http://www.medigraphic.com/pdfs/salmen/sam-2010/sam103a.pdf |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
