Costi del trattamento con oloprazina nelle fasi iniziali della schizofrenia

Objective: In Italy, use of olanzapine in the public sector was limited by law to patients that had failed treatment with conventional antipsychotics, due to the higher purchase price of the drug. This restriction prevented first-episode patients and patients early in the course of their illness from being treated with olanzapine. The present study investigates economic consequences of this policy. Design: The present study retrospectively outlines treatment costs of patients switched to olanzapine during the early stages of schizophrenia as compared to the costs of patients switched during a later stage of the illness. Setting: The study was conducted within Italian Community Mental Health Services. Patients: The cost of pharmacological and non-pharmacological treatment was retrospectively calculated in 25 out-patients with schizophrenia and related disorders over a one-year span. Thirteen patients were switched to olanzapine in the early stage of their illness, prior to drug approval under a compassionate use regimen. Twelve patients started olanzapine under the restriction in a later stage of illness following failed treatment with a conventional antipsychotic. Results: While total treatment costs between the two groups was similar, cost distribution was different. Early Switch patients had higher drug costs and higher rehabilitation costs, while Late Switch patients had higher hospitalisation costs. Conclusions: Small patient numbers and design limitations prevent conclusions being drawn regarding the ultimate impact on outcome and total treatment cost of restriction of olanzapine to second-line use. Despite this, our findings demonstrate that within the context of the Italian CMHS, patients treated with olanzapine while still in the early stages of schizophrenia do not necessarily cost more overall compared to patients who receive olanzapine after failing treatment with a conventional antipsychotic

Subjective response to antipsychotic treatment and compliance in schizophrenia. A naturalistic study comparing olanzapine, risperidone and haloperidol (EFESO Study)

BACKGROUND: In order to compare the effectiveness of different antipsychotic drugs in the treatment of schizophrenia it is very important to evaluate subjective response and compliance in patient cohorts treated according to routine clinical practice. METHOD: Outpatients with schizophrenia entered this prospective, naturalistic study when they received a new prescription for an antipsychotic drug. Treatment assignment was based on purely clinical criteria, as the study did not include any experimental intervention. Patients treated with olanzapine, risperidone or haloperidol were included in the analysis. Subjective response was measured using the 10-item version of the Drug Attitude Inventory (DAI-10), and treatment compliance was measured using a physician-rated 4 point categorical scale. RESULTS: A total of 2128 patients initiated treatment (as monotherapy) with olanzapine, 417 with risperidone, and 112 with haloperidol. Olanzapine-treated patients had significantly higher DAI-10 scores and significantly better treatment compliance compared to both risperidone- and haloperidol-treated patients. Risperidone-treated patients had a significantly higher DAI-10 score compared to haloperidol-treated patients. CONCLUSION: Subjective response and compliance were superior in olanzapine-treated patients, compared to patients treated with risperidone and haloperidol, in routine clinical practice. Differences in subjective response were explained largely, but not completely, by differences in incidence of EPS

T4-Related Bacteriophage LIMEstone Isolates for the Control of Soft Rot on Potato Caused by ‘Dickeya solani’

The bacterium ‘Dickeya solani’, an aggressive biovar 3 variant of Dickeya dianthicola, causes rotting and blackleg in potato. To control this pathogen using bacteriophage therapy, we isolated and characterized two closely related and specific bacteriophages, vB_DsoM_LIMEstone1 and vB_DsoM_LIMEstone2. The LIMEstone phages have a T4-related genome organization and share DNA similarity with Salmonella phage ViI. Microbiological and molecular characterization of the phages deemed them suitable and promising for use in phage therapy. The phages reduced disease incidence and severity on potato tubers in laboratory assays. In addition, in a field trial of potato tubers, when infected with ‘Dickeya solani’, the experimental phage treatment resulted in a higher yield. These results form the basis for the development of a bacteriophage-based biocontrol of potato plants and tubers as an alternative for the use of antibiotics

Costi del trattamento con oloprazina nelle fasi iniziali della schizofrenia

Objective: In Italy, use of olanzapine in the public sector was limited by law to patients that had failed treatment with conventional antipsychotics, due to the higher purchase price of the drug. This restriction prevented first-episode patients and patients early in the course of their illness from being treated with olanzapine. The present study investigates economic consequences of this policy. Design: The present study retrospectively outlines treatment costs of patients switched to olanzapine during the early stages of schizophrenia as compared to the costs of patients switched during a later stage of the illness. Setting: The study was conducted within Italian Community Mental Health Services. Patients: The cost of pharmacological and non-pharmacological treatment was retrospectively calculated in 25 out-patients with schizophrenia and related disorders over a one-year span. Thirteen patients were switched to olanzapine in the early stage of their illness, prior to drug approval under a compassionate use regimen. Twelve patients started olanzapine under the restriction in a later stage of illness following failed treatment with a conventional antipsychotic. Results: While total treatment costs between the two groups was similar, cost distribution was different. Early Switch patients had higher drug costs and higher rehabilitation costs, while Late Switch patients had higher hospitalisation costs. Conclusions: Small patient numbers and design limitations prevent conclusions being drawn regarding the ultimate impact on outcome and total treatment cost of restriction of olanzapine to second-line use. Despite this, our findings demonstrate that within the context of the Italian CMHS, patients treated with olanzapine while still in the early stages of schizophrenia do not necessarily cost more overall compared to patients who receive olanzapine after failing treatment with a conventional antipsychotic

Clinical and Economic Outcomes of Olanzapine Compared With Haloperidol for Schizophrenia: Results From a Randomised Clinical Trial

Objective: The purpose of this study was to compare, from the payor perspective, the clinical and economic outcomes of olanzapine to those of haloperidol for the treatment of schizophrenia. Design and setting: Clinical, quality-of-life and resource utilisation data were prospectively collected for US-residing patients with schizophrenia who were participating in a multicentre, randomised, double-blind clinical trial comparing olanzapine and haloperidol. Direct medical costs were estimated by assigning standardised prices (1995 values) to the resource utilisation data. Patients and participants: 817 patients with schizophrenia who had a baseline Brief Psychiatric Rating Scale score (BPRS) >=18 (items scored 0 to 6) and/or were no longer tolerating current antipsychotic therapy. Interventions: Olanzapine 5 to 20 mg/day (n = 551) or haloperidol 5 to 20 mg/day (n = 266) for 6 weeks. Patients showing a predefined level of clinical response entered a 46-week maintenance phase. Main outcome measures and results: After acute treatment, BPRS-based clinical improvements were seen in 38 and 27% of olanzapine and haloperidol patients, respectively (p = 0.002). Clinically important improvements on the Quality of Life Scale were achieved during acute treatment in 33% of olanzapine recipients and 25% of haloperidol recipients (p = 0.094). Olanzapine treatment in the acute phase led to significantly lower inpatient ($US5125 vs$US5795, p = 0.038) and outpatient ($US663 vs$US692, p = 0.001) costs, resulting in a significant overall reduction in mean total medical costs of $US388 (p = 0.033). This significant reduction in total costs was found despite olanzapine mean medication costs being significantly greater than haloperidol medication costs ($US326 vs $US15, pPharmacoeconomics, Olanzapine, Schizophrenia, Randomised-controlled-trials, Quality-of-life, Hospitalisation, Resource-use, Maintenance-therapy, Haloperidol, Community-care

Direct and Indirect Costs of Non-Vertebral Fracture Patients with Osteoporosis in the US

Background: Osteoporosis is a condition marked by low bone mineral density and the deterioration of bone tissue. One of the main clinical and economic consequences of osteoporosis is skeletal fractures. Objective: To assess the healthcare and work loss costs of US patients with non-vertebral (NV) osteoporotic fractures. Methods: Privately insured (aged 18-64 years) and Medicare (aged ≥65 years) patients with osteoporosis (ICD-9-CM code: 733.0x) were identified during 1999-2006 using two claims databases. Patients with an NV fracture (femur, pelvis, lower leg, upper arm, forearm, rib or hip) were matched randomly on age, sex, employment status and geographic region to controls with osteoporosis and no fractures. Patient characteristics and annual healthcare costs were assessed over the year following the index fracture for privately insured (n - 4764) and Medicare (n - 48 742) beneficiaries (Medicare drug costs were estimated using multivariable models). Indirect (i.e. work loss) costs were calculated for a subset of privately insured, employed patients with available disability data (n - 1148). All costs were reported in &dollar;US, year 2006 values. Results: In Medicare, mean incremental healthcare costs per NV fracture patient were &dollar;US13 387 (&dollar;US22 466 vs &dollar;US9079; p < 0.05). The most expensive patients had index fractures of the hip, multiple sites and femur (incremental costs of &dollar;US25 519, &dollar;US20 137 and &dollar;US19 403, respectively). Patients with NV non-hip (NVNH) fractures had incremental healthcare costs of &dollar;US7868 per patient (&dollar;US16 704 vs &dollar;US8836; p < 0.05). Aggregate annual incremental healthcare costs of NVNH patients in the Medicare research sample (n - 35 933) were &dollar;US282.7 million compared with &dollar;US204.1 million for hip fracture patients (n - 7997). Among the privately insured, mean incremental healthcare costs per NV fracture patient were &dollar;US5961 (&dollar;US11 636 vs &dollar;US5675; p < 0.05). The most expensive patients had index fractures of the hip, multiple sites and pelvis (incremental costs of &dollar;US13 801, &dollar;US9642 and &dollar;US8164, respectively). Annual incremental healthcare costs per NVNH patient were &dollar;US5381 (&dollar;US11 090 vs &dollar;US5709; p < 0.05). Aggregate annual incremental healthcare costs of NVNH patients in the privately insured sample (n - 4478) were &dollar;US24.1 million compared with &dollar;US3.5 million for hip fracture patients (n - 255). Mean incremental work loss costs per NV fracture employee were &dollar;US1956 (&dollar;US4349 vs &dollar;US2393; p < 0.05). Among patients with available disability data, work loss accounted for 29.5% of total costs per NV fracture employee. Conclusion: The cost burden of NV fracture patients to payers is substantial. Although hip fracture patients were more costly per patient in both Medicare and privately insured samples, NVNH fracture patients still had substantial incremental costs. Because NVNH patients accounted for a larger proportion of the fracture population, they were associated with greater aggregate incremental healthcare costs than hip fracture patients.Cost-of-illness, Fracture, treatment, Hip-fracture, treatment, Osteoporosis, treatment

Olanzapine versus Risperidone: A Prospective Comparison of Clinical and Economic Outcomes in Schizophrenia

Objective: To compare the clinical and economic outcomes associated with olanzapine and risperidone treatment for schizophrenia. Design and setting: An international, multicentre, double-blind, prospective study. To facilitate economic comparisons, our sample was restricted to patients enrolled in US sites. 150 patients with a Diagnostic and Statistical Manual of mental disorders, 4th edition (DSM-IV) diagnosis of schizophrenia, schizoaffective disorder or schizophreniform disorder were randomised to therapy with either olanzapine 10 to 20 mg/day (n = 75) or risperidone 4 to 12 mg/day (n = 75) for a maximum of 28 weeks. In addition to tolerability and efficacy assessments, use of health services was assessed at baseline and prospectively, at 8-week intervals and at study completion. Clinically important response, defined as a 40% improvement in the Positive and Negative Syndrome Scale total score, maintenance of response and rates of treatment-emergent extrapyramidal symptoms were compared between groups. Direct medical costs were estimated by assigning standardised prices to resource units. Median total, inpatient/outpatient service and medication acquisition costs were compared between treatment groups. Main outcome measures and results: The mean modal dosages for the olanzapine and risperidone treatment groups were 17.7 +- 3.4 mg/day and 7.9 +- 3.2 mg/day, respectively. Olanzapine-treated patients were more likely to maintain response compared with risperidone-treated patients (p = 0.048). In addition, a smaller proportion of olanzapine-treated patients required anticholinergic therapy compared with risperidone-treated patients (25.3 vs 45.3%; p = 0.016). Total per patient medical costs over the study interval were $US2843 (1997 values) [36$US2513 vs $US1581; pAntipsychotics, Cost analysis, Olanzapine, Pharmacoeconomics, Risperidone, Schizophrenia

Classifying patients by antipsychotic adherence patterns using latent class analysis:characteristics of nonadherent groups in the California Medicaid (Medi-Cal) program

AbstractObjectivesThis study identifies latent classes defined by varying degrees of adherence to antipsychotic drug therapy and examines the sociodemographic, clinical, and resource utilization correlates associated with membership in each adherence class.Data and methodsPatient-level data were drawn from the 1994 to 2003, 100%-sample California Medicaid fee-for-service paid claims data for patients with schizophrenia (N = 36,195). The date of the first antipsychotic medication filled after January 1, 1999 was then used to divide each patient's data into a 6-month preindex (baseline) and a 12-month postindex (follow-up) period. Three categorical adherence indicators—a dichotomous variable of medication possession ratio greater than 0.80, the number of antipsychotic treatment attempts, and time to a change in antipsychotic medications—and two covariates—a categorical variable of duration of therapy and a dichotomous variable of polypharmacy—were used in the latent class model.ResultsA three-class model returned the lowest values for all the information criteria and was therefore interpreted as follows: The prevalence rates of the latent classes were 1) 14.8% for the adherent; 2) 20.7% for the partially adherent; and 3) 64.5% for the nonadherent. Membership in the nonadherent class was associated with minority ethnicity, being female, eligibility due to welfare status, prior hospitalizations, and a higher number of prior treatment episodes. Membership in the partially adherent class was associated with higher use of outpatient care, higher rates of depot antipsychotic drug use, and polypharmacy.ConclusionMultiple indicators of adherence to antipsychotic medication can be used to define classes of adherence that are associated with patient characteristics and distinct patterns of prior health-care use

Frequency of Hospitalisations and Inpatient Care Costs of Manic Episodes: In Patients with Bipolar I Disorder in France

Background: Bipolar disorder is a chronic illness that may involve multiple relapses and result in substantial psychosocial impairment. However, very few recent studies have investigated the economic burden of the disease. Objective: To assess the frequency of hospitalisation and the inpatient care costs associated with manic episodes in patients with bipolar I disorder in France. Method: A cost-of-illness study was conducted based on available data using a hospital payer perspective. The lifetime prevalence of manic episodes was estimated from published epidemiological data using a random-effects meta-analysis. Data were obtained by a computerised literature search using the main scientific and medical databases. Additional epidemiological references were identified from published studies and textbooks. Data on frequency of hospitalisation and length of stay were collected from a large psychiatric university hospital. Data on unit costs for inpatient care were obtained from the accounting system of the largest hospital group in Paris, France for the year 1999. Results: Extrapolating from international data on the average prevalence of bipolar I disorder, the proportion of rapid cycling patients and the average cycle duration, we estimated the annual number of manic episodes in patients with bipolar I disorder to be around 265 Conclusion: Our study highlights the lack of medical and economic data on the frequency and hospitalisation-related costs of manic episodes in patients with bipolar I disorder in France. As the lifetime prevalence of bipolar I disorder may be as high as 3% among adults, further studies are required in order to provide representative national data and to allow economic evaluations of costs related to bipolar I disorder in France.Bipolar-I-disorders, Cost-analysis, Hospitalisation, Pharmacoeconomics