Hyde et al. 1998Laurier et al. 1997
Type of studyCost minimisation; prospective, sequential.Cost consequence analysis; based on modelling.
Country / settingUK; PICU.Canada; one psychiatric one general hospital; and literature.
Year of studyDec 94 - Jan 96 from single PICU.1992 - 94 for costs from two hospitals.
PatientsIn-patients with diagnosis of schizophrenia, mania, manic depression, substance misuse or other acute psychosis.Schizophrenic patients hospitalised subsequent to A&E visit.
InterventionsIM zuclopenthixol acetate (Z) vs. IM haloperidol (H) for rapid tranquillisation.
Dosage per injectionZ 25-150 mg; H 5-30 mg (dosage per incident not reported).Z 50-200mg; H 7-12 mg (dosage per incident not reported).
Sample sizeZ 26; H 16.N/A for outcomes; 44 for costs.
Outcome measuresEffectiveness implicitly assumed same; side effects (drowsiness, tremor, rigor, dystonia, akathisia, visual disturbances and orofacial movements) recorded.Control of psychotic symptoms; degree of sedation; frequency of extrapyramidal symptoms.
Source of outcome dataPrimary data collection in one hospital.Review of trial literature.
Cost measuresDirect costs: nursing staff costs, medical staff costs, damage to property, injury to people, drug prices.Direct costs: basic hospital stay, drugs, physician visits, diagnostic tests, nursing care.
Source of cost dataPrimary data collection in one hospital.Z: review of trial literature; H: primary data collection from 2 hospitals.
Duration of studyEntire episodes.Nine days from A&E admission.
Other considerationsCollected data on staff attitude towards the two drugs.Model built around the number of injections required. Source of this info is the literature for Z and primary data for H.
Main results
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Side effects comparable.

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Drug cost per patient eight times higher for Z (GBP23 vs. GBP3).

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Special nursing cost per patient two times lower for Z (386:794).

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Total cost per patient two times lower for Z (469:863).

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20/21 staff preferred Z over H.

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Similar control of symptoms.

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Similar side effects.

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More frequent injections with H.

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Incremental cost of 50mg Z against 50mg H is CAD21-25.

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Largest cost component basic hospital stay; similar for both drugs.

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Next cost component is nursing.

Sensitivity analysisNone.
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Incremental cost of 100mg Z against 50mg H is CAD44-48.

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Z at either dosage may have cost savings, depending on distribution of number of injections required.

Comments
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Results reported per patient during study period as opposed to per incidence (which may not be same).

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Distribution of no. of injections seems counterintuitive.

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Not clear why baseline case compares equal dosage of two drugs.

From: Appendix 9, Health economics report

Cover of Violence
Violence: The Short-Term Management of Disturbed/Violent Behaviour in In-Patient Psychiatric Settings and Emergency Departments.
NICE Clinical Guidelines, No. 25.
National Collaborating Centre for Nursing and Supportive Care (UK).
Copyright © 2006, Royal College of Nursing.

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