González Gisela Paula, Moscoso Nebel Silvana, Lago Fernando Pablo
National University of the South (UNS), Bahía Blanca, Buenos Aires, Argentina.
Institute of Economic and Social Research of the South (IIESS-CONICET-UNS), Bahía Blanca, Buenos Aires, Argentina.
Pharmacoecon Open. 2018 Sep;2(3):233-239. doi: 10.1007/s41669-017-0058-8.
Schizophrenia is considered a serious mental disorder that affects over 21 million people worldwide, and is associated with disability that frequently affects the patient's educational and working performance. In Argentina, two of the most widely used antipsychotics in the treatment of this disorder are haloperidol and risperidone. Both are provided free to patients without health coverage in public healthcare facilities. In this paper we seek to review the clinical and economic benefits of prescribing psychotropic therapies based on haloperidol (a first-generation antipsychotic that is part of the butyrophenone group of drugs) versus risperidone [an atypical or second-generation antipsychotic (neuroleptic) drug] in adult patients who have been diagnosed with schizophrenia. To achieve this objective, an exhaustive search of relevant articles published between 2006 and April 2017 was conducted. This literature search showed that intermittent treatment usually fails to prevent relapses due to irregular protection, therefore continuous treatment is more effective. Although the injectable formats of both drugs [haloperidol depot and long-acting injectable risperidone (LAIR)] have not proven to have significant differences with regard to clinical effectiveness vis-à-vis the tablet formats, they showed a lower cost-effectiveness ratio by reducing patients' relapses. Moreover, LAIR exhibits superior cost effectiveness compared with haloperidol depot. Haloperidol is less expensive than risperidone but is less cost effective; in comparison with haloperidol, treatment with risperidone produces (1) an improvement in quality-adjusted life-years, and (2) a significant reduction in negative symptoms. In most cases, antipsychotic treatments are effective in controlling the positive and negative symptoms associated with schizophrenia, allowing patients to live in their communities without any impairments. However, it is extremely important to combine pharmacological treatment with other measures that constitute psychosocial therapy.
精神分裂症被认为是一种严重的精神障碍，全球有超过2100万人受其影响，并且与残疾相关，这种残疾常常影响患者的教育和工作表现。在阿根廷，治疗这种疾病最广泛使用的两种抗精神病药物是氟哌啶醇和利培酮。在公共医疗设施中，这两种药物都免费提供给没有医保的患者。在本文中，我们试图回顾对于已被诊断为精神分裂症的成年患者，基于氟哌啶醇（一种第一代抗精神病药物，属于丁酰苯类药物）与利培酮[一种非典型或第二代抗精神病（神经安定）药物]开具精神otropic疗法的临床和经济效益。为实现这一目标，我们对2006年至2017年4月期间发表的相关文章进行了详尽搜索。该文献搜索表明，间歇治疗通常因保护不规律而无法预防复发，因此持续治疗更有效。尽管这两种药物的注射剂型[氟哌啶醇长效注射剂和长效注射用利培酮（LAIR）]在临床有效性方面与片剂剂型相比未显示出显著差异，但它们通过减少患者复发显示出较低的成本效益比。此外，与氟哌啶醇长效注射剂相比，LAIR表现出更高的成本效益。氟哌啶醇比利培酮便宜，但成本效益较低；与氟哌啶醇相比，使用利培酮治疗可（1）改善质量调整生命年，以及（2）显著减轻阴性症状。在大多数情况下，抗精神病治疗有效地控制了与精神分裂症相关的阳性和阴性症状，使患者能够在社区中生活而无任何障碍。然而，将药物治疗与构成心理社会治疗的其他措施相结合极为重要。
