Analyse coût-efficacité des stratégies de prise en charge des patients schizophrènes : place d'un antipsychotique atypique sous forme injectable à libération prolongée

The schizophrenia is a relatively frequent disease. In France, every year, the adult care public sector welcomes approximately 150 000 patients affected by schizophrenia, among whom most are going to require a follow-up for many years. According to the French Psychiatric Federation, continuous regimens of moderate doses entail a diminished relapse risk, less re-hospitalisations, and maybe a diminished tardive dyskinesia risk ; they favour better compliance to the treatment which is probably linked to a better alliance between the patient and his physician. Improved compliance entailing an improved state of health is a plausible hypothesis which has, indeed, already been demonstrated. The benefit obtained thanks to improved compliance may go beyond purely medical aspects and entail a social benefit, which is at present very difficult to quantify. In view of the serious nature of the disorder and the frequent incidence of schizophrenia, there are not that many pharmacoeconomics published studies. The cost of the disorder has been little studied and the outcomes of such work must be interpreted on the basis of the specific characteristics of the national health care systems. No study has been made to compare the benefits of a long-acting atypical antipsychotic with those of another atypical antipsychotic or with a depot formulation conventional neuroleptic. The results observed in the various studied scenarios show a clinical and economic superiority of LA risperidone with regard to haloperidol depot and almost always with regard to olanzapine. It can suggest that a use of long-acting risperidone in first line is desirable for a better medical and economic benefit.