Cost variation of antipsychotics in the public health system in Brazil: the implication for health resource use

Abstract

Objective: This study aimed to verify the variation on antipsychotics costs according to four unit costs paid by public health providers in Brazil. Methods: This cross-sectional study used the health provider perspective and bottom-up approach to evaluate 134 subjects with mental disorders, in regular use of antipsychotics, and living in 20 residential services in the city of Sao Paulo between 2011 and 2012. They were assessed for psychiatric diagnosis, the severity of symptoms, quality of life, independent living skills, pattern of health service use and treatments. The Brazilian version of Client Socio-demographic Services Receipt Inventory (ISDUCS) was used to assess health service and medication use. Four different values of unit costs for each antipsychotic were extracted from Medication Price Database (Banco de Preços de Saúde) by the Ministry of Health, Brazil. Results: Variability on the unit costs for chlorpromazine was found by 25,600 fold to the lowest values. Similarly, mean costs of chlorpromazine use per capita per diem varied between BRL 0.55 and BRL 357.87, that is, a difference by 650 fold to the lowest value. Conclusion: The great variability in the unit costs paid by public health providers for all antipsychotics hinders any guideline recommendation for the best cost-saving choice of antipsychotics. It is paramount to proceed cost-effectiveness studies verifying acceptable thresholds for treatments according to the national budget. Yet, monitoring public resource use on the antipsychotic purchasing is imperative to avoid waste of public resources.