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Abstract
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
Keywords
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© 1997 Published by Elsevier Inc.
