Research Article| Volume 19, ISSUE 2, P316-329, March 1997

Economic evaluation of zuclopenthixol acetate compared with injectable haloperidolin schizophrenic patients with acute psychosis

      This paper is only available as a PDF. To read, Please Download here.


      Zuclopenthixol acetate is a rapid-acting, injectable neuroleptic drug with a duration of action that allows for administration once every 2 to 3 days, in contrast to injectable haloperidol, which may require administration more than once daily. To assess the place of zuclopenthixol acetate in the treatment of acute episodes of schizophrenia, a cost-consequence analysis was performed comparing this new medication with short-acting, injectable haloperidol. The perspective of the Quebec health care system was adopted. The study population comprised patients diagnosed with schizophrenia who experienced an acute episode of psychosis and who were treated with intramuscular (IM) haloperidol. The study assessed patients for 9 days after the start of treatment. The literature was the principal source of comparative data about the clinical outcomes of the two treatments. The total cost associated with zuclopenthixol acetate IM or haloperidol IM was modeled using a decision tree built around the number of IM injections required to achieve stabilization. To establish costs, expert panels were consulted and patients' files were reviewed for a sample of schizophrenic patients who had been hospitalized in a large psychiatric or general hospital subsequent to a visit to the emergency department and had received a short-acting IM neuroleptic drug. Only direct medical costs were considered. Because zuclopenthixol acetate was not on the market at the time of the study, the file review did not allow for a direct estimate of its related costs but did provide an account of haloperidol use. The literature shows that zuclopenthixol acetate is similar to haloperidol with respect to the control of psychotic episodes; however, zuclopenthixol acetate is associated with increased sedation and a lower incidence of extrapyramidal symptoms. Using the base-case estimate for the number of injections required for stabilization, the incremental cost of zuclopenthixol acetate 50 mg over haloperidol was $25.00 (1995 Canadian dollars) per patient at the psychiatric hospital and $21.00 per patient at the general hospital. The results were sensitive to the estimate of the number of injections and the number of minutes of nursing care required by agitated patients. Zuclopenthixol acetate resulted in cost savings over haloperidol if it permits a reduction of 25% in minutes of nursing care or if 85% of patients require 2 injections or less (45% requiring 1 injection and 40% requiring 2). However, whichever drug is used, the cost of the injectable neuroleptic represents a small fraction of the cost of care for acutely psychotic patients


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Therapeutics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Terkelsen KG
        • Menikoff A
        Measuring the costs of schizophrenia.
        PharmacoEconomics. 1995; 8: 199-222
      1. Schizophrenic disorders.
        in: Berkow R Fletcher AJ Bondy PK 17th ed. The Merck Manual. Merck & Co, Inc, Rahway, NJ1992: 1614-1615
        • Ereshefsky L
        • Riesenman C
        Choice of drug and dose.
        Neuropsychopharmacology. 1994; 10 (Abstract S-109-483): 502S
        • Saltzman C
        • Solomon D
        • Miyawaki E
        • et al.
        Parenteral lorazepam versus parenteral haloperidol for the control of psychotic disruptive behavior.
        J Clin Psychiatry. 1991; 52: 177-180
        • Amdisen A
        • Nielsen MS
        • Dencker SJ
        • et al.
        Zuclopenthixol acetate in Viscoleo®—a new drug formulation. An open Nordic multicentre study of zuclopenthixol acetate in Viscoleo® in patients with acute psychoses including mania and exacerbation of chronic psychoses.
        Acta Psychiatr Scand. 1987; 75: 99-107
      2. Canadian Coordinating Office for Health Technology Assessment.
        Guidelines for Economic Evaluation of Pharmaceuticals. Canadian Coordinating Office for Health Technology Assessment, Ottawa, Canada1994
        • Bobon D
        • De Bleeker E
        Zuclopenthixol acetate and haloperidol in acute psychotic patients.
        A randomized multicentre study. Presented at the ECNP Congress. 24261989; (Gothenburg, Sweden. Abstract)
        • Bobon D
        • De Bleeker E
        Zuclopenthixol acetate and haloperidol in acute psychotic patients. A randomized multicentre study.
        in: Wistedt B Depot Antipsychotic in Chronic Schizophrenia. Proceedings of a Symposium; October 14, 1989; Athens, Greece. Excerpta Medica, Amsterdam1990: 47-59
        • Bourdouxhe S
        • Mirel J
        • Denys W
        • et al.
        L'acetate de zuclopenthixol et l'haloperidol dans la psychose aigue.
        Acta Psychiatr Belg. 1987; 87: 236-244
        • Baastrup PC
        • Alhfors UG
        • Bjerkenstedt L
        • et al.
        A controlled Nordic multicentre study of zuclopenthixol in oil solution, haloperidol and zuclopenthixol in the treatment of acute psychosis.
        Acta Psychiatr Scand. 1993; 87: 48-58
        • Balant LP
        • Balant-Gorgia AE
        • Eisele R
        • et al.
        Clinical and pharmacokinetic evaluation of zuclopenthixol acetate in Viscoleo®.
        Pharmacopsychiatry. 1989; 22: 250-254
        • Chakravarti SK
        • Muthu A
        • Muthu PK
        • et al.
        Zuclopenthixol acetate (5% in Viscoleo®): Single-dose treatment for acutely disturbed psychotic patients.
        Curr Med Res Opin. 1990; 12: 58-65
        • Chouinard G
        • Safadi G
        • Beauclair L
        A double-blind controlled study of intramuscular zuclopenthixol acetate and liquid oral haloperidol in the treatment of schizophrenic patients with acute exacerbation.
        J Clin Psychopharmacol. 1994; 14: 377-384
        • Farid BT
        • Qureshi MJH
        • Mortimer AM
        • et al.
        A new concept in the management of acute psychosis: Zuclopenthixol acetate (5% in Viscoleo).
        Eur J Clin Res. 1991; 1: 13-23
        • Hebenstreit GF
        Zuclopenthixol acetate and co-injection of zuclopenthixol decanoate in relapse cases.
        in: Wistedt B Depot Antipsychotic in Chronic Schizophrenia. Proceedings of a Symposium; October 14, 1989; Athens, Greece. Excerpta Medica, Amsterdam1990: 37-46
        • Matar AM
        • Abdel-Mawgoud A
        • Skov S
        Zuclopenthixol: A new generation of antipsychotic drugs. An open clinical trial.
        J Clin Psychopharmacol. 1990; 10: 283-287
        • Lowert AC
        • Rasmussen EM
        • Holm R
        • et al.
        Acute psychotic disorders treated with 5% zuclopenthixol acetate in ‘Viscoleo’ (Cisordinol-Acutard'), a global assessment of the clinical effect: An open multicentre study.
        Pharmacotherapeutica. 1989; 5: 380-386
        • Omerov M
        • Wistedt B
        • Durling U
        Aggressive incident and acute psychosis: The effect of zuclopenthixol acetate.
        Regional Symposium, World Psychiatric Association. 23261990; (Presented at the) (Oslo, Norway)