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OBJECTIVES: Health economic assessment of cost-effectiveness parameters for the comparison of typical (Haloperidol), partially atypical depot (Flupentixol) and atypical neuroleptics (Olanzapin, Risperidon) in the treatment of schizophrenia from the perspective of German health insurance. METHODS: A published markov model was rebuilt and calibrated with DATA®, taking into consideration relapse rates, extrapyramidal symptoms (EPS) and other prognostic symptoms. All data were derived from published sources where available. Besides the comparison of monotherapy, a stepwise treatment scenario was simulated, starting with three months Olanzapin treatment followed by Flupentixol. Over the 5-year simulation period cumulated complication rates (percentage of relapse, positive and negative symptoms), patient related outcomes (Brief Psychiatric Rating Score “BPRS”) and cost parameters (medication, EPS-cost and total costs) were assessed. A cost-effectiveness analysis was performed. RESULTS: Olanzapin/Flupentixol in combination had the lowest relapse rate (42.9 %), followed by Flupentixol (44.4%), Olanzapin (44.8%), Risperidon (48.0 %) and Haloperidol (57.6%). Olanzapin treatment showed the highest BPRS score (3.13), followed by Risperidon (3.07), Olanzapin/Flupentixol (2.52), Flupentixol (2.42) and Haloperidol (2.37). The most cost-effective treatment measured by cost in DEM per relapse free patient was Olanzapin/Flupentixol (200,000), followed by Olanzapin (211,000), Flupentixol (212,000), Risperidon (231,000) and Haloperidol (287,000). The best cost-effectiveness (expressed in DEM/BPRS) was observed in Olanzapin (37,100), followed by Risperidon (39,100), Olanzapin/Flupentixol (45,500), Flupentixol (48,600) and Haloperidol (51,400). Total 5-year drug cost (DEM) were 24,600, 26,800, 3,800, 2,700 and 3,210 respectively. CONCLUSIONS: In terms of relapse rates Olanzapin and Flupentixol lead to better clinical outcome and better cost-effectiveness results as compared to alternative typical or atypical neuroleptic therapy. With Olanzapin and Risperidon most favorable BPRS scores were achieved. Flupentixol depot as monotherapy or following initial Olanzapin treatment is a cost-effective alternative to atypical neuroleptics at low drug cost and low relapse rates.

OBJECTIVES: German hospitals receive the same reimbursement by the statutory health insurance for CABG surgery irrespective of whether or not a rethoracotomy, which involves higher in-hospital costs, has to be performed following hemorrhage. In order to evaluate the in-hospital costs for CABG with and without rethoracotomy from the hospital perspective, a cost-analysis of CABG surgery was performed. Furthermore, the cost-effectiveness of prophylactic administration of the antihemorrhagic agent aprotinin was investigated. METHODS: The detailed resource utilization of 138 CABG patients, 68 with rethoracotomy and 70 without, was analysed based on sample of patient medical records from 7 German hospitals. Resource costs were provided by hospital administrations and supplemented by literature. The overall costs for both groups were then combined with rethoracotomy rates in patients with and without prophylactic administration of aprotinin derived from a published meta-analysis of all relevant clinical trials in open heart surgery. RESULTS: The total in-hospital costs per patient with CABG were on average DM 21,241 and increased to DM 31,326 for a CABG patient requiring rethoracotomy. Besides the costs of the rethoracotomy, the costs of intensive care were the main cost driver in patients with rethoracotomy. The meta-analysis showed with statistical significance that aprotinin can reduce the rethoracotomy rate from 5.0% to 1.8% in patients undergoing heart surgery. When combining the cost data with the results of the meta-analysis, the expected average costs per patient treated with aprotinin (including drug costs) were DM 21,432 compared to DM 21,655 per patient without aprotinin treatment. A cost-effectiveness analysis (costs per patient without rethoracotomy) resulted in a difference of DM 970 in favour of the prophylactic antihemorrhagic treatment. CONCLUSION: The analysis showed that CABG patients requiring an additional rethoracotomy generated about 47% higher costs than patients with CABG surgery only. The administration of the antihemorrhagic agent aprotinin can be recommended in the light of the reduced complication rate and improved cost-effectiveness of CABG-surgery.