Patterns of utilization of antipsychotic drugs and direct medical costs among patients with schizophrenia in a tertiary care hospital

Table 1 Cost calculation (per mg) of olanzapine as a model drug

Drug brands (generic name)	Tablets (number) in one strip/package with dose (mg) of each tablet	Cost (Indian rupees) of one strip/package
Tolaz MD 10 (olanzapine)	10 tablets, 10 mg each	29
Oleanz 10 (olanzapine)	10 tablets, 10 mg each	86
Olan 10 (olanzapine)	10 tablets, 10 mg each	65
Olanz 10 (olanzapine)	10 tablets, 10 mg each	48
Olimelt 10 (olanzapine)	10 tablets, 10 mg each	78
Dopin 10 (olanzapine)	10 tablets, 10 mg each	62
Jolyon 10 (olanzapine)	10 tablets, 10 mg each	55
Lanopin 10 (olanzapine)	10 tablets, 10 mg each	61
Olandus 10 (olanzapine)	10 tablets, 10 mg each	51
Olexar 10 (olanzapine)	10 tablets, 10 mg each	47

Total dose = 100 tablets = 100 × 10 = 1000 mg. Total cost = 582 Indian rupees for 100 tablets. Total dose = (number of tablets in one strip/package multiplied by dose of each tablet) × number of strips/packages. Per mg cost = total cost (Indian rupees)/total dose (mg) = 582/1000 = 0.58 Indian rupees per mg.

Table 2 Baseline sociodemographic characteristics and clinical profile of patients with schizophrenia

Age (years)	Number of patients (n = 159)	Percentage (%)
< 18	14	8.8
18-30	98	61.6
31-40	29	18.2
> 40	18	11.3
Gender distribution of study population
Age (years)	mean	SD
Age (n = 159)	27.74	9.76
Age for men (n = 90)	26.74	9.04
Age for women (n = 69)	29.04	10.55
Frequency of comorbidities
Comorbidity	Frequency (n = 92)	Relative frequency (%)
F17 (nicotine dependence)	23	0.25
F12.2 (cannabis dependence)	9	0.10
F10.2 (alcohol dependence)	5	0.05
E66.9 (obesity)	10	0.11
Other psychiatric comorbidities	33	0.36
Other non-psychiatric comorbidities	12	0.13

Table 3 History of duration of illness distribution and substance abuse of study population

History of illness (in months)	Number of patients (n = 159)	Mean years of history of illness for subcategories	SD
< 6 months	40	3.49	1.77
6-12 months	42	11.05	1.71
13-24 months	77	21.74	2.93
0-24 months	159	14.32	8.06
Substance abuse in study population
Characteristic	Alcohol use	Tobacco use	Cannabis use
Yes (present)	20	35	15
No (absent)	139	124	144
Total	159	159	159

Table 4 Anatomical therapeutic chemical/defined daily dose classification with calculated daily defined dose per 1000 inhabitants per day, prescribed daily dose, and prescribed daily dose/daily defined dose ratio

Drug	ATC code	DDD (mg)	DID (mg)	PDD (mg)	PDD/DDD
Fluphenazine	N05AB02	1	0.0794	1.40	1.400
Trifluoperazine	N05AB06	20	0.0030	7.59	0.380
Haloperidol	N05AD01	8	0	4.50	0.560
Olanzapine	N05AH03	10	1.5600	14.36	1.436
Risperidone	N05AX08	5	0.3745	3.55	0.710
Aripiprazole	N05AX12	15	0.2237	11.56	0.770
Amisulpride	N05AL05	400	0.0755	212.95	0.530
Quetiapine	N05AH04	400	0.0062	78.53	0.190
Lurasidone	N05AE05	60	0.0184	48.17	0.800
Clozapine	N05AH02	300	0.0066	185.38	0.620

ATC: Anatomical therapeutic chemical; DDD: Defined daily dose; DID: Daily defined dose per 1000 inhabitants per day; PDD: Prescribed daily dose.

Table 5 Direct medical cost of study population

Cost (Indian rupees)	2016 (n = 79)	2017 (n = 49)	2018 (n = 34)	Total	P value
Cost for typical antipsychotics	360.00 ± 158.75	219.67 ± 113.09	74.00 ± 00.00	259.00 ± 155.69	0.273
Cost for atypical antipsychotics	2820.62 ± 5983.78	1857.50 ± 1850.72	1970.88 ± 1198.21	2320.79 ± 4221.25	0.395
Cost for antipsychotics	1985.77 ± 2591.01	1870.18 ± 1844.14	1973.06 ± 1197.55	1945.25 ± 2111.71	0.953
Cost for concomitant drugs	845.17 ± 928.98	2220.23 ± 6117.17	1401.98 ± 1308.57	1396.23 ± 3680.37	0.188
Total cost for drugs	3483.21 ± 5947.95	3578.04 ± 5805.69	2715.28 ± 1595.96	3350.01 ± 5257.89	0.729
Total cost for investigations	991.28 ± 1290.30	924.55 ± 920.49	1193.18 ± 1394.26	1017.34 ± 1211.16	0.614
Total direct medical cost	4389345 ± 6062.51	4560.83 ± 5910.86	3883.37 ± 2266.12	4337.28 ± 5400.07	0.847

Data are presented as mean ± SD.