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The impact of antipsychotic polytherapy costs in the public health care in Sao Paulo, Brazil.

ABSTRACT: Guidelines for the treatment of psychoses recommend antipsychotic monotherapy. However, the rate of antipsychotic polytherapy has increased over the last decade, reaching up to 60% in some settings. Studies evaluating the costs and impact of antipsychotic polytherapy in the health system are scarce.To estimate the costs of antipsychotic polytherapy and its impact on public health costs in a sample of subjects with psychotic disorders living in residential facilities in the city of Sao Paulo, Brazil.A cross-sectional study that used a bottom-up approach for collecting costs data in a public health provider's perspective. Subjects with psychosis living in 20 fully-staffed residential facilities in the city of Sao Paulo were assessed for clinical and psychosocial profile, severity of symptoms, quality of life, use of health services and pharmacological treatment. The impact of polytherapy on total direct costs was evaluated.147 subjects were included, 134 used antipsychotics regularly and 38% were in use of antipsychotic polytherapy. There were no significant differences in clinical and psychosocial characteristics between polytherapy and monotherapy groups. Four variables explained 30% of direct costs: the number of antipsychotics, location of the residential facility, time living in the facility and use of olanzapine. The costs of antipsychotics corresponded to 94.4% of the total psychotropic costs and to 49.5% of all health services use when excluding accommodation costs. Olanzapine costs corresponded to 51% of all psychotropic costs.Antipsychotic polytherapy is a huge economic burden to public health service, despite the lack of evidence supporting this practice. Great variations on antipsychotic costs explicit the need of establishing protocols for rational antipsychotic prescriptions and consequently optimising resource allocation. Cost-effectiveness studies are necessary to estimate the best value for money among antipsychotics, especially in low and middle income countries.

SUBMITTER: Razzouk D

PROVIDER: S-EPMC4390144 | biostudies-other | 2015

REPOSITORIES: biostudies-other

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Project description:ObjectivesWe investigated whether perceived social support among adolescent students moderated the association between violence exposure and internalising symptoms in São Paulo city, Brazil.MethodsWe tested the stress-buffering model using data from the cross-sectional school-based, survey São Paulo Project on the Social Development of Children and Adolescents. Internalising symptoms were measured using an adapted version of the Social Behaviour Questionnaire; serious victimisation, being bullied once/week, school violence and community violence, friend and teacher support were scales adapted by the research team; the Alabama Parenting Questionnaire measured parenting style. Linear mixed-effects models were used to quantify moderation effects of (i) social support between violence exposure and internalising symptoms and (ii) gender between violence exposure and internalising symptoms across schools.ResultsAcross schools, being bullied once/week, school violence, and community violence were associated with a significant (p<0.001) increase in internalising symptoms (e.g., bullied b = 5.76, 95% CI 2.26, 9.26; school violence b = 0.48, 95% CI 0.30, 0.67; community violence b = 0.36; 95% CI 0.22, 0.50). Males exposed to all types of violence had significantly lower (p<0.01) internalising symptoms compared to females (e.g., serious victimisation: b = -1.45; 95% CI -2.60, -0.29; school violence b = -0.27; 95% CI -0.30, -0.24; community violence b = -0.23; 95% CI -0.25, -0.20). As a main effect, social support was associated with a significant (p<0.01) decrease in internalising symptoms across schools (e.g., positive parenting b = -2.42; 95% CI -3.12, -1.72; parent involvement b = -2.75; 95% CI -3.32, -2.17; friend support b = -1.05; 95% CI -1.74, -0.34; teacher support b = -0.90; 95% CI -1.58, -0.22). Social support did not moderate the association between violence exposure and internalising symptoms.ConclusionsAdolescent students in São Paulo exposed to violence have a higher likelihood of internalising symptoms, compared to those who are not. Support from parents, friends, and teachers, independent of violence, appear to be protective against internalising symptoms, pointing to potential programmes that could improve adolescent mental health.

Project description:BackgroundWorld population growth is projected to be concentrated in megacities, with increases in social inequality and urbanization-associated stress. São Paulo Metropolitan Area (SPMA) provides a forewarning of the burden of mental disorders in urban settings in developing world. The aim of this study is to estimate prevalence, severity, and treatment of recently active DSM-IV mental disorders. We examined socio-demographic correlates, aspects of urban living such as internal migration, exposure to violence, and neighborhood-level social deprivation with 12-month mental disorders.Methods and resultsA representative cross-sectional household sample of 5,037 adults was interviewed face-to-face using the WHO Composite International Diagnostic Interview (CIDI), to generate diagnoses of DSM-IV mental disorders within 12 months of interview, disorder severity, and treatment. Administrative data on neighborhood social deprivation were gathered. Multiple logistic regression was used to evaluate individual and contextual correlates of disorders, severity, and treatment. Around thirty percent of respondents reported a 12-month disorder, with an even distribution across severity levels. Anxiety disorders were the most common disorders (affecting 19.9%), followed by mood (11%), impulse-control (4.3%), and substance use (3.6%) disorders. Exposure to crime was associated with all four types of disorder. Migrants had low prevalence of all four types compared to stable residents. High urbanicity was associated with impulse-control disorders and high social deprivation with substance use disorders. Vulnerable subgroups were observed: women and migrant men living in most deprived areas. Only one-third of serious cases had received treatment in the previous year.DiscussionAdults living in São Paulo megacity had prevalence of mental disorders at greater levels than similar surveys conducted in other areas of the world. Integration of mental health promotion and care into the rapidly expanding Brazilian primary health system should be strengthened. This strategy might become a model for poorly resourced and highly populated developing countries.

Project description:To estimate the prevalence of one month psychotropic drug use in São Paulo, Brazil, and to assess the gap treatment between the presence of mental disorders and psychotropic drug users.A probabilistic sample of non-institutionalized individuals from the general population of São Paulo (n = 2336; turnout: 84.5%) who were 15 years or older were interviewed by a trained research staff, applying the Composite International Diagnostic Interview 2.1 (CIDI WHO) (depression, anxiety-phobia, OCD\PTSD, alcoholism sections), and an inventory investigating psychotropic drug use during the 12-month and one-month periods immediately preceding the interview. Logistic models were fitted to investigate associations between psychotropic drug use as well as socio-demographic and clinical variables.The one month prevalence of psychotropic drug use in São Paulo was 5.89%, the most commonly used drugs were antidepressants (3.15%) and tranquilizers (2.67%). A higher consumption of psychotropic drugs (overall, antidepressants and tranquilizers) was observed among women (OR:2.42), older individuals (OR:1.04), individuals with higher levels of formal education (1.06), and individuals with a family (OR:2.29) or personal history of mental illness (OR:3.27). The main psychotropic drug prescribers were psychiatrists (41%), followed by general practitioners (30%); 60% of psychotropic drugs were obtained through a government-run dispensing program. Most individuals who obtained a positive diagnosis on the CIDI 2.1 during the previous month were not using psychotropic medication (85%). Among individuals with a diagnosis of moderate to severe depression, 67.5% were not on any pharmacological treatment.There is a change in the type of psychotropic more often used in São Paulo, from benzodiazepines to antidepressants, this event is observed in different cultures. The prevalence of use is similar to other developing countries. Most of the patients presenting a psychiatric illness in the month prior to testing were not receiving any sort of psychiatric medication. This may be explained by a failure to identify cases in primary care, which could be improved (and access to treatment could be facilitated) if professionals received more specialized training in managing cases with mental health problems.

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The impact of antipsychotic polytherapy costs in the public health care in Sao Paulo, Brazil.

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