OBJECTIVES: The aim of the study was to evaluate the clinical and economic feasibility of using classical and atypical antipsychotics for the inpatient and outpatient treatment of schizophrenia from the position of the Russian Federation public health system, and society as a whole.

METHODS: The methodology of the study included two complementary stages: a pharmacoepidemiological study of the main aspects of therapy and the course of schizophrenia at the inpatient and outpatient phases of medical care on the basis of hospitals and psycho-neurological dispensaries in St. Petersburg, and subsequent mathematical modeling. In carrying out the pharmacoeconomic analysis, a cost-effectiveness analysis (CEA) was conducted to calculate the cost-effectiveness ratio (CER), incremental analysis with the calculation of the corresponding incremental cost-effectiveness ratios (ICERs), and budget impact analysis with a one-year and two-year perspectives.

RESULTS: Therapy with atypical antipsychotics (AA) is characterized by significantly greater total costs in the therapy of patients with schizophrenia. The use of classical antipsychotics (CA) is less expensive and cost-effective if the continuity of antipsychotic pharmacotherapy between the inpatient and outpatient units of psychiatric care is maintained. Use of generic AA can reduce the cost of drug provision, though does not lead to a change in pharmacoeconomic indicators to the level of effectiveness and appropriateness. When considering direct and indirect costs for the population included in this study with a 15.6% level of employment, the use of generic AA (at 100% replacement level of reference AA) was less expensive compared to the therapy with CA. With a modeled 100% employment rate of schizophrenic patients, all variants of using AA became less costly strategies in comparison with CA.

CONCLUSIONS: Planning drug supply for patients with schizophrenia requires a rational choice of the CA and AA shares to minimize the additional burden on the health budget.