Trends in the use of antipsychotic drugs in Lithuania on 2003-2005 year. Evaluation of effectiveness of antipsychotics.Meta-analysis

Abstract

Objective: To evaluate trends in the use of antipsychotic drugs in Lithuania between 2003 and 2005 years. Methods: The data on total sales of antipsychotic drugs in all Lithuanian regions over three years (2003-2005) were obtained from IMS Health Inc. Drugs were classified according to the Anatomic Therapeutic Chemical system and use was quantified in terms of defined daily doses. Meta-analysis of observational studies retrieved through systematic search of all available electronic data sources. 1651 abstracts were found and checked. 76 randomised double-blind studies were identified for the met-analysis. Data were calculated by DDD methodology and expressed in DDDs per 1.000 inhabitants per day. The pharmacoeconomic analysis of antipsychotics was performed by cost minimization and reference price methodology. Results: In Lithuania the total antipsychotics consumption increased by 16% over three years (2003-2005) period reaching the value of 5,5 DDD/1000 inhabitants/day. Since 2003 the proportion of use of conventional antipsychotics has increased by 2%, while the use of atypical antipsychotics has increased by 14%. The expenditures of antipsychotics has reached 39 mln Litas (in 2005), of which 48% was costs for atypical antipsychotic agents. Setting the reference price of risperidone (according to the meta-analysis results of effectiveness) for atypical antipsychotics it would be possible to rationalize schizophrenia treatment using 10,68 mln Litas extra money. Conclusions: The findings suggest that the use of total antipsychotic drugs continues to increase because of the increased use of atypical antipsychotics and some conventional antipsychotics. According to the meta-analysis results risperidone is the most effective drug for schizophrenia treatment. Considering the similar efficacy of other atypical antipsychotics and the increased high expenditures of atypical antipsychotics it is extremely important to consider the cost-effectiveness of antipsychotics. Performed cost-minimization analysis using the reference-based pricing estimated the possible reduction of total antipsychotics expenditures by 28% and the possible schizophrenia treatment rationalization.