RESUMO
BACKGROUND: Antipsychotic medications are the primary treatment for schizophrenia, with olanzapine being an effective medication for schizophrenia. The economic cost for each individual with schizophrenia is high, with antipsychotic medication being a major expense. This study aims to develop an economic decision model that compares different treatment options for schizophrenia patients, including olanzapine Orally Dispersible Tablets (ODT), olanzapine [ODT + Standard Oral Tablet (SOT)], risperidone (ODT + SOT), and aripiprazole (ODT + SOT), to determine their cost-effectiveness with an objective to optimize healthcare resource allocation in Morocco. METHODS: The study used published medical literature and a clinical expert panel to develop a decision analytic model. This model was designed to capture parameters such as adherence levels, treatment discontinuation, relapse with and without hospitalization, quality-adjusted life years (QALYs), treatment-related adverse events, healthcare resource utilization, and associated costs. The main outcomes of interest included the total annual direct cost per treatment, QALYs, and incremental cost-effectiveness ratio (ICER) per 1 QALY gained. One-way and probabilistic sensitivity analyses were employed to account for parameter uncertainty. RESULTS: According to the simulation model, the ODT and ODT + SOT as a group form of olanzapine was the most effective treatment option in terms of the lowest percentages of inpatient relapse, and patients who remained stable (11% and 79% respectively) than risperidone (19% and 62% respectively) and aripiprazole ODT (26% and 50% respectively) and ODT + SOT formulation groups. Olanzapine (ODT + SOT) therapy group was cost-effective when compared to the combined group of ODT + SOT forms of risperidone [ICER: Moroccan Dirham (MAD) 103,907], and aripiprazole (ICER: MAD 65,047). Additionally, olanzapine ODT was found to be cost-effective compared to olanzapine SOT with an ICER of MAD 3921, risperidone ODT with an ICER of MAD 1,02,298, risperidone SOT with an ICER of MAD 31,088, and aripiprazole ODT or SOT formulations. All the above ICERs fall under the willingness-to-pay threshold in Morocco of MAD 250,832.40. Sensitivity analyses confirmed the reliability of the findings. CONCLUSIONS: The model concluded that olanzapine ODT is the most cost-effective first-line treatment option for schizophrenia in Morocco when compared to other atypical antipsychotic medications in ODT and SOT formulations.
RESUMO
BACKGROUND: Certain unknown aspects of ropinirole action, such as its antidepressant effect after chronic administration and on cotreatment with fluoxetine, remain to be evaluated, which formed the rationale for this study. METHODS: Wistar rats of either sex (weighing 150-200 g) were used. In the dose-finding study, oral dose of ropinirole (20 mg/kg) was selected. This was combined with two different doses of fluoxetine (10 and 20 mg/kg). Their antidepressant-like effects were compared in acute and chronic forced-swim test (FST). Acute FST was conducted in two sessions after administration of three doses within 24 h. Chronic FST was conducted over 14 days. Drugs were administered each day for 14 days. Effect on locomotor activity was tested in OFT. RESULTS: ANOVA with post hoc Tukey test was used. Dose-finding study of ropinirole showed that out of three doses, 20 mg/kg produced maximum reduction in immobility in acute FST (137±8 s). Coadministration of ropinirole with fluoxetine in acute FST further reduced immobility (107±8 s). This effect was more prominent in chronic forced-swim-stressed rats (74±2 s). Neither ropinirole nor its coadministration with fluoxetine increased locomotor activity in open-field test. CONCLUSIONS: The potential of ropinirole to act as an antidepressant agent is proven by the reduction in immobility time in FST. Further, there is an augmentation of the effect of fluoxetine by ropinirole, suggesting synergistic interaction of dopamine and serotonin pathway in brain.