Magazine article Drug Topics

Novel Psychotropics Asre Worth Their Price, Say Users

Magazine article Drug Topics

Novel Psychotropics Asre Worth Their Price, Say Users

Article excerpt

Gary Viale is glad to see his drug budget increase every year. As assistant director for mental health in the Santa Clara Valley Health and Hospital System, he watched expenditures for clozapine alone jump from $870,000 in February 1996 to $1.1 million in April 1997.

"That's the fiscal equivalent of hiring one new psychiatrist every month," Viale told the recent Seventh Annual Public Health Pharmacy Issues Conference in Vancouver, British Columbia. Viale's agency administers the Medicaid program in Santa Clara County, the Silicon Valley area south of San Francisco. How does he justify that kind of expenditure? Through cost savings in other areas.

Patients on first-generation antidepressants have refill rates around 20%, Viale explained. Patients on fluoxetine (Prozac, Dista) have a 75% refill rate because of the lower side-effect profile.

"Nobody ever walked through my door and asked for the latest tricyclic antidepressant," he said. "They're asking for Prozac and other newer products. They know we have something to offer that was never available in the past."

Psychiatric pharmacy has similar success stories in most other areas. Bipolar disease, for example, traditionally treated with lithium, is now routinely controlled in Santa Clara with divalproex sodium (Depakote, Abbott), which costs twice as much as lithium. The difference comes in the length of stay. The average lithium patient needs 1 7.6 inpatient treatment days versus 10.2 days required for patients prescribed divalproex.

"Time is money these days," Viale said. He added that using the more expensive drug saves the county Medicaid program $4,693 per patient per episode. "We're using an expensive medication and saving money. That's not easy for some people to understand, but it's the bean counters who are driving the savings."

The story is similar for schizophrenia. The traditional treatment, haloperidol, costs about $87 per patient per year. …

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