6533b7d5fe1ef96bd1264618

RESEARCH PRODUCT

Cost-effectiveness of psychotropic polypharmacy in routine schizophrenia care. Results of the ELAN prospective observational trial

subject

description

Abstract Aims To analyse the costs and cost-effectiveness of psychotropic polypharmacy in comparison to antipsychotic monotherapy in patients with schizophrenia and schizo-affective disorder under real-world treatment conditions. Methods A prospective observational study including 374 adult psychiatric in-patients with schizophrenia or schizo-affective disorder was conducted. Psychotropic regimen, clinical outcomes, and quality of life were assessed before discharge and after 6, 12, 18, and 24 months. Costs and outcomes of psychotropic polypharmacy in comparison to antipsychotic monotherapy were analysed by means of mixed-effects regression models adjusted for propensity scores. Net-benefit regression was conducted for the assessment of cost-effectiveness, controlling for psychopathology, drug-side effects, and propensity scores. Results Combinations of antipsychotic drugs and augmentation of antipsychotic drugs with other psychotropic substances were related to higher direct treatment costs and to higher total (direct and indirect) costs compared to antipsychotic monotherapy. Polypharmacy was either less or similarly effective as antipsychotic monotherapy. Antipsychotic monotherapy produced a significant net monetary benefit compared to all types of polypharmacy except the combination of antipsychotics with mood stabilisers. Conclusions Statistical associations between type of psychopharmacological treatment on the one hand and the net monetary benefit on the other suggest that antipsychotic monotherapy is related to lower costs and better outcomes in comparison to any type of polypharmaceutical treatment. Further studies with more rigorous study designs are necessary to further elucidate the direction of causality in the detected associations.