The impact of antipsychotic polytherapy costs in the public health care in Sao Paulo, Brazil
Guidelines for the treatment of psychoses recommend antipsychotic monotherapy. However, the rate of antipsychotic polytherapy has increased over the last decade, reaching up to 60% in some settings. Studies evaluating the costs and impact of antipsychotic polytherapy in the health system are scarce....
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| creator | Razzouk, Denise Kayo, Monica Sousa, Aglaé Gregorio, Guilherme Cogo-Moreira, Hugo Cardoso, Andrea Alves Mari, Jair de Jesus |
| description | Guidelines for the treatment of psychoses recommend antipsychotic monotherapy. However, the rate of antipsychotic polytherapy has increased over the last decade, reaching up to 60% in some settings. Studies evaluating the costs and impact of antipsychotic polytherapy in the health system are scarce.
To estimate the costs of antipsychotic polytherapy and its impact on public health costs in a sample of subjects with psychotic disorders living in residential facilities in the city of Sao Paulo, Brazil.
A cross-sectional study that used a bottom-up approach for collecting costs data in a public health provider's perspective. Subjects with psychosis living in 20 fully-staffed residential facilities in the city of Sao Paulo were assessed for clinical and psychosocial profile, severity of symptoms, quality of life, use of health services and pharmacological treatment. The impact of polytherapy on total direct costs was evaluated.
147 subjects were included, 134 used antipsychotics regularly and 38% were in use of antipsychotic polytherapy. There were no significant differences in clinical and psychosocial characteristics between polytherapy and monotherapy groups. Four variables explained 30% of direct costs: the number of antipsychotics, location of the residential facility, time living in the facility and use of olanzapine. The costs of antipsychotics corresponded to 94.4% of the total psychotropic costs and to 49.5% of all health services use when excluding accommodation costs. Olanzapine costs corresponded to 51% of all psychotropic costs.
Antipsychotic polytherapy is a huge economic burden to public health service, despite the lack of evidence supporting this practice. Great variations on antipsychotic costs explicit the need of establishing protocols for rational antipsychotic prescriptions and consequently optimising resource allocation. Cost-effectiveness studies are necessary to estimate the best value for money among antipsychotics, especially in low and middle income countries. |
| doi_str_mv | 10.1371/journal.pone.0124791 |
| format | Article |
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To estimate the costs of antipsychotic polytherapy and its impact on public health costs in a sample of subjects with psychotic disorders living in residential facilities in the city of Sao Paulo, Brazil.
A cross-sectional study that used a bottom-up approach for collecting costs data in a public health provider's perspective. Subjects with psychosis living in 20 fully-staffed residential facilities in the city of Sao Paulo were assessed for clinical and psychosocial profile, severity of symptoms, quality of life, use of health services and pharmacological treatment. The impact of polytherapy on total direct costs was evaluated.
147 subjects were included, 134 used antipsychotics regularly and 38% were in use of antipsychotic polytherapy. There were no significant differences in clinical and psychosocial characteristics between polytherapy and monotherapy groups. Four variables explained 30% of direct costs: the number of antipsychotics, location of the residential facility, time living in the facility and use of olanzapine. The costs of antipsychotics corresponded to 94.4% of the total psychotropic costs and to 49.5% of all health services use when excluding accommodation costs. Olanzapine costs corresponded to 51% of all psychotropic costs.
Antipsychotic polytherapy is a huge economic burden to public health service, despite the lack of evidence supporting this practice. Great variations on antipsychotic costs explicit the need of establishing protocols for rational antipsychotic prescriptions and consequently optimising resource allocation. Cost-effectiveness studies are necessary to estimate the best value for money among antipsychotics, especially in low and middle income countries.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0124791</identifier><identifier>PMID: 25853709</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adult ; Antipsychotic agents ; Antipsychotic Agents - economics ; Antipsychotic Agents - therapeutic use ; Antipsychotics ; Benzodiazepines - economics ; Benzodiazepines - therapeutic use ; Brazil ; Cost-Benefit Analysis ; Costs ; Cross-Sectional Studies ; Drug therapy ; Drug Therapy, Combination ; Economic aspects ; Economic impact ; Female ; Health aspects ; Health care ; Health care costs ; Health care policy ; Health services ; Humans ; Male ; Mental disorders ; Mental health care ; Mental Health Services - economics ; Olanzapine ; Pharmacology ; Polypharmacy ; Practice Patterns, Physicians' - economics ; Psychiatry ; Psychosis ; Psychotic Disorders - drug therapy ; Psychotic Disorders - economics ; Psychotic Disorders - physiopathology ; Psychotropic drugs ; Public health ; Public Health - economics ; Quality of Life ; Residential location ; Resource allocation ; Schizophrenia ; Signs and symptoms</subject><ispartof>PloS one, 2015-04, Vol.10 (4), p.e0124791-e0124791</ispartof><rights>COPYRIGHT 2015 Public Library of Science</rights><rights>2015 Razzouk et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2015 Razzouk et al 2015 Razzouk et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-74e1c2c70f8933e5d1db8c5d1f9e14a048dd1f637d21e383e2a251f13a430eeb3</citedby><cites>FETCH-LOGICAL-c692t-74e1c2c70f8933e5d1db8c5d1f9e14a048dd1f637d21e383e2a251f13a430eeb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4390144/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4390144/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25853709$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Stewart, Robert</contributor><creatorcontrib>Razzouk, Denise</creatorcontrib><creatorcontrib>Kayo, Monica</creatorcontrib><creatorcontrib>Sousa, Aglaé</creatorcontrib><creatorcontrib>Gregorio, Guilherme</creatorcontrib><creatorcontrib>Cogo-Moreira, Hugo</creatorcontrib><creatorcontrib>Cardoso, Andrea Alves</creatorcontrib><creatorcontrib>Mari, Jair de Jesus</creatorcontrib><title>The impact of antipsychotic polytherapy costs in the public health care in Sao Paulo, Brazil</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Guidelines for the treatment of psychoses recommend antipsychotic monotherapy. However, the rate of antipsychotic polytherapy has increased over the last decade, reaching up to 60% in some settings. Studies evaluating the costs and impact of antipsychotic polytherapy in the health system are scarce.
To estimate the costs of antipsychotic polytherapy and its impact on public health costs in a sample of subjects with psychotic disorders living in residential facilities in the city of Sao Paulo, Brazil.
A cross-sectional study that used a bottom-up approach for collecting costs data in a public health provider's perspective. Subjects with psychosis living in 20 fully-staffed residential facilities in the city of Sao Paulo were assessed for clinical and psychosocial profile, severity of symptoms, quality of life, use of health services and pharmacological treatment. The impact of polytherapy on total direct costs was evaluated.
147 subjects were included, 134 used antipsychotics regularly and 38% were in use of antipsychotic polytherapy. There were no significant differences in clinical and psychosocial characteristics between polytherapy and monotherapy groups. Four variables explained 30% of direct costs: the number of antipsychotics, location of the residential facility, time living in the facility and use of olanzapine. The costs of antipsychotics corresponded to 94.4% of the total psychotropic costs and to 49.5% of all health services use when excluding accommodation costs. Olanzapine costs corresponded to 51% of all psychotropic costs.
Antipsychotic polytherapy is a huge economic burden to public health service, despite the lack of evidence supporting this practice. Great variations on antipsychotic costs explicit the need of establishing protocols for rational antipsychotic prescriptions and consequently optimising resource allocation. Cost-effectiveness studies are necessary to estimate the best value for money among antipsychotics, especially in low and middle income countries.</description><subject>Adult</subject><subject>Antipsychotic agents</subject><subject>Antipsychotic Agents - economics</subject><subject>Antipsychotic Agents - therapeutic use</subject><subject>Antipsychotics</subject><subject>Benzodiazepines - economics</subject><subject>Benzodiazepines - therapeutic use</subject><subject>Brazil</subject><subject>Cost-Benefit Analysis</subject><subject>Costs</subject><subject>Cross-Sectional Studies</subject><subject>Drug therapy</subject><subject>Drug Therapy, Combination</subject><subject>Economic aspects</subject><subject>Economic impact</subject><subject>Female</subject><subject>Health aspects</subject><subject>Health care</subject><subject>Health care costs</subject><subject>Health care policy</subject><subject>Health services</subject><subject>Humans</subject><subject>Male</subject><subject>Mental disorders</subject><subject>Mental health care</subject><subject>Mental Health Services - economics</subject><subject>Olanzapine</subject><subject>Pharmacology</subject><subject>Polypharmacy</subject><subject>Practice Patterns, Physicians' - economics</subject><subject>Psychiatry</subject><subject>Psychosis</subject><subject>Psychotic Disorders - drug therapy</subject><subject>Psychotic Disorders - economics</subject><subject>Psychotic Disorders - physiopathology</subject><subject>Psychotropic drugs</subject><subject>Public health</subject><subject>Public Health - economics</subject><subject>Quality of Life</subject><subject>Residential location</subject><subject>Resource allocation</subject><subject>Schizophrenia</subject><subject>Signs and symptoms</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk21r1EAQx4Motp5-A9GAIAreuU_ZJG-EWnw4KFRs9ZWwTDaTuy172bibiOend6-Xlov0heTFLjO_-c_OZCZJnlKyoDynb6_c4Fuwi861uCCUibyk95JjWnI2l4zw-wf3o-RRCFeEZLyQ8mFyxLIi4zkpj5Mfl2tMzaYD3aeuSaHtTRe2eu16o9PO2W2_Rg_dNtUu9CE1bRoNaTdUNvrXCLZfpxo87jwX4NIvMFj3Jn3v4Y-xj5MHDdiAT8Zzlnz7-OHy9PP87PzT8vTkbK5lyfp5LpBqpnPSFCXnmNW0rgodj6ZEKoCIoo53yfOaUeQFRwYsow3lIDhBrPgseb7X7awLamxMUFTmlJGCShmJ5Z6oHVypzpsN-K1yYNS1wfmVAh9LtqhqDpksaM55xgWtJORMQ8NIlQGWusKo9W7MNlQbrDW2vQc7EZ16WrNWK_dLCV4SKkQUeDUKePdzwNCrjQkarYUW3XD9biaJzGMzZsmLf9C7qxupFcQCTNu4mFfvRNWJYCXPBZe7tIs7qPjVuDE6TlFjon0S8HoSEJkef_crGEJQy4uv_8-ef5-yLw_Y_RAFZ4feuDZMQbEHtXcheGxum0yJ2i3BTTfUbgnUuAQx7NnhD7oNupl6_hdS_AEx</recordid><startdate>20150408</startdate><enddate>20150408</enddate><creator>Razzouk, Denise</creator><creator>Kayo, Monica</creator><creator>Sousa, Aglaé</creator><creator>Gregorio, Guilherme</creator><creator>Cogo-Moreira, Hugo</creator><creator>Cardoso, Andrea Alves</creator><creator>Mari, Jair de Jesus</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20150408</creationdate><title>The impact of antipsychotic polytherapy costs in the public health care in Sao Paulo, Brazil</title><author>Razzouk, Denise ; Kayo, Monica ; Sousa, Aglaé ; Gregorio, Guilherme ; Cogo-Moreira, Hugo ; Cardoso, Andrea Alves ; Mari, Jair de Jesus</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-74e1c2c70f8933e5d1db8c5d1f9e14a048dd1f637d21e383e2a251f13a430eeb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Antipsychotic agents</topic><topic>Antipsychotic Agents - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Razzouk, Denise</au><au>Kayo, Monica</au><au>Sousa, Aglaé</au><au>Gregorio, Guilherme</au><au>Cogo-Moreira, Hugo</au><au>Cardoso, Andrea Alves</au><au>Mari, Jair de Jesus</au><au>Stewart, Robert</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The impact of antipsychotic polytherapy costs in the public health care in Sao Paulo, Brazil</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2015-04-08</date><risdate>2015</risdate><volume>10</volume><issue>4</issue><spage>e0124791</spage><epage>e0124791</epage><pages>e0124791-e0124791</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Guidelines for the treatment of psychoses recommend antipsychotic monotherapy. However, the rate of antipsychotic polytherapy has increased over the last decade, reaching up to 60% in some settings. Studies evaluating the costs and impact of antipsychotic polytherapy in the health system are scarce.
To estimate the costs of antipsychotic polytherapy and its impact on public health costs in a sample of subjects with psychotic disorders living in residential facilities in the city of Sao Paulo, Brazil.
A cross-sectional study that used a bottom-up approach for collecting costs data in a public health provider's perspective. Subjects with psychosis living in 20 fully-staffed residential facilities in the city of Sao Paulo were assessed for clinical and psychosocial profile, severity of symptoms, quality of life, use of health services and pharmacological treatment. The impact of polytherapy on total direct costs was evaluated.
147 subjects were included, 134 used antipsychotics regularly and 38% were in use of antipsychotic polytherapy. There were no significant differences in clinical and psychosocial characteristics between polytherapy and monotherapy groups. Four variables explained 30% of direct costs: the number of antipsychotics, location of the residential facility, time living in the facility and use of olanzapine. The costs of antipsychotics corresponded to 94.4% of the total psychotropic costs and to 49.5% of all health services use when excluding accommodation costs. Olanzapine costs corresponded to 51% of all psychotropic costs.
Antipsychotic polytherapy is a huge economic burden to public health service, despite the lack of evidence supporting this practice. Great variations on antipsychotic costs explicit the need of establishing protocols for rational antipsychotic prescriptions and consequently optimising resource allocation. Cost-effectiveness studies are necessary to estimate the best value for money among antipsychotics, especially in low and middle income countries.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>25853709</pmid><doi>10.1371/journal.pone.0124791</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2015-04, Vol.10 (4), p.e0124791-e0124791 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1671208166 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS); EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adult Antipsychotic agents Antipsychotic Agents - economics Antipsychotic Agents - therapeutic use Antipsychotics Benzodiazepines - economics Benzodiazepines - therapeutic use Brazil Cost-Benefit Analysis Costs Cross-Sectional Studies Drug therapy Drug Therapy, Combination Economic aspects Economic impact Female Health aspects Health care Health care costs Health care policy Health services Humans Male Mental disorders Mental health care Mental Health Services - economics Olanzapine Pharmacology Polypharmacy Practice Patterns, Physicians' - economics Psychiatry Psychosis Psychotic Disorders - drug therapy Psychotic Disorders - economics Psychotic Disorders - physiopathology Psychotropic drugs Public health Public Health - economics Quality of Life Residential location Resource allocation Schizophrenia Signs and symptoms |
| title | The impact of antipsychotic polytherapy costs in the public health care in Sao Paulo, Brazil |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-05T12%3A14%3A00IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=The%20impact%20of%20antipsychotic%20polytherapy%20costs%20in%20the%20public%20health%20care%20in%20Sao%20Paulo,%20Brazil&rft.jtitle=PloS%20one&rft.au=Razzouk,%20Denise&rft.date=2015-04-08&rft.volume=10&rft.issue=4&rft.spage=e0124791&rft.epage=e0124791&rft.pages=e0124791-e0124791&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0124791&rft_dat=%3Cgale_plos_%3EA429374364%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1671208166&rft_id=info:pmid/25853709&rft_galeid=A429374364&rft_doaj_id=oai_doaj_org_article_d3a56817335341b6a72caf20b5ae9cbe&rfr_iscdi=true |