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Methodological issues in assessing changes in costs pre- and post-medication switch: a schizophrenia study example.
Douglas E Faries1, Allen W Nyhuis, Haya Ascher-Svanum
1Lilly USA, LLC, Indianapolis, Indiana, USA. d.faries@lilly.com
Switching antipsychotics for schizophrenia may appear costly due to crisis events, but sensitivity analyses reveal potential cost savings. Careful analysis of acute care costs is crucial for accurate treatment cost comparisons.
Area of Science:
- Health Economics
- Psychiatric Research
- Pharmacoeconomics
Background:
- Schizophrenia is a severe, chronic, and costly illness impacting patients and healthcare budgets.
- Cost comparisons of schizophrenia treatment regimens are vital for payers and researchers.
- Pre-Post analyses are common but may not accurately attribute costs around medication switches.
Purpose of the Study:
- To investigate the impact of acute care costs on Pre-Post analyses of medication switching in schizophrenia.
- To assess the sensitivity of cost-effectiveness findings to the handling of crisis-related expenditures post-medication change.
Main Methods:
- Utilized medical resource data from a 1-year randomized schizophrenia trial (n=105) involving antipsychotic switches.
- Calculated within-patient daily cost changes during pre- and post-medication switch periods.
- Conducted sensitivity analyses to evaluate the attribution of acute care costs following medication failure.
Main Results:
- Standard Pre-Post analysis indicated a $2.40/day increase in costs post-switch.
- Fifty-six percent of first-week costs on new antipsychotics were linked to previous treatment failure.
- Sensitivity analyses, excluding crisis costs, showed a decrease in costs from $4.77 to $9.69 per day post-switch.
Conclusions:
- Pre-Post cost analyses are highly sensitive to the methodology for handling acute service costs after medication changes.
- Thorough sensitivity analyses are essential to accurately determine the economic impact of switching antipsychotic treatments.
- Understanding crisis event costs is critical for quality economic research in schizophrenia treatment.
