| Summary: | 碩士 === 高雄醫學大學 === 藥學研究所碩士在職專班 === 94 === The purpose of this study was to investigate the possibilities of applying pharmacoeconomics (PE) to the hospital formulary management using atypical antipsychotic drugs as the study drug. Cost-effectiveness analysis of PE was performed from the Pharmacy and Therapy Committee point of view. Twenty-six weeks therapy duration was set as the treatment course in this study. All possible costs resulted from 26-week chronic antipsychotic therapy, including total drug costs, costs of assumed 13 clinical visits and others, were taken into consideration when they were available to obtain. The efficacy data of these atypical antipsychotic drugs were obtained from a published systemic review reference, with PANSS or BPRS as the surrogate marker. Based on the currently published clinical research, differences of drug efficacy due to ethnicity were assumed to be so small that could even be ignored in this study. The unit drug price was obtained from the website of National Health Insurance, Taiwan, R.O.C., on the date of August 24, 2005. The selective treatment doses for these atypical antipsychotic drugs were based on the defined daily dose (DDD) published by WHO in 2005. Clozapine was not included for comparison, because it is the final drug of choice for antipsychotic therapy when others are failed. Sertindole was also excluded because of its withdrawal from marketplace. A sensitivity test was conducted based on drug cost resulted from 26-weeks therapy. The results obtained from C/E ratio are shown as following: zotepine (NT$3,258,846, the lowest C/E ratio), amisulpride (NT$3,552,182), risperidone (NT$4,470,612), olanzapine (NT$5,013,281), ziprasidone (NT$5,980,000), and quetiapine (NT$8,568,750 the highest). Compared with zotepine, the sequences from the lowest to the highest cost based on ICER was amisulpride (NT$8,636,666) followed by olanzapine (NT$12,615,833).
The results of C/E ratio showed that the most cost-effective drug among these atypical antipsychotics was zotepine. To compare with zotepine, the best results of ICER was amisulpride. With result of this research the cost of drug was a major factor contributed to total medical costs. The results obtained from this study may be challenged when there is evidence shown that the drug efficacies are varied due to ethnical factor in the future. In conclusion, the PE analysis used in this study seems feasible to support the hospital formulary management for the selection of atypical antipsychotic drugs.
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