Original Research

A retrospective record review and assessment of cost of quetiapine use in a community psychiatric setting in the Sedibeng district of Gauteng

Lesley J. Robertson, Jacqui K. Miot, Bernard Janse van Rensburg
South African Journal of Psychiatry | Vol 23 | a1057 | DOI: https://doi.org/10.4102/sajpsychiatry.v23i0.1057 | © 2017 Lesley J. Robertson, Jacqui K. Miot, Bernard Janse van Rensburg | This work is licensed under CC Attribution 4.0
Submitted: 08 September 2016 | Published: 17 July 2017

About the author(s)

Lesley J. Robertson, Department of Psychiatry, School of Clinical Medicine, University of the Witwatersrand, South Africa
Jacqui K. Miot, Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, South Africa
Bernard Janse van Rensburg, Department of Psychiatry, School of Clinical Medicine, University of the Witwatersrand, South Africa


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Abstract

Background: With the revision of the National Essential Medicines List in South Africa, quetiapine is only available at the discretion of individual institutions in the public health sector. However, quetiapine is effective in managing all aspects of bipolar disorder, including preventative treatment of depressive episodes, and may be a cost-effective option in severe illness.

Aim: To present the first retrospective review of quetiapine use in a peri-urban health district of South Africa, describing the patient profile, clinical response and prescribing patterns.

Methods: The clinical files of all patients in Sedibeng District who received quetiapine over a defined 3-year period (2011–2013) were reviewed. A positive clinical response was defined as both symptomatic and functional improvement. Demographic and clinical characteristics of responders were compared with that of non-responders. Pre- and post-quetiapine scripts of the responders were audited and costed.

Results: Patients who received quetiapine (n = 40) had chronic disabling illness, often with multiple medication trials and hospitalisations prior to quetiapine use. Bipolar II disorder (followed by bipolar I disorder) was the most common primary psychiatric diagnosis documented. Other than improvement in functioning (p < 0.0001), responders differed significantly from non-responders in terms of a higher level of polypharmacy and a significant reduction in median number of medications from pre- to post-quetiapine (p = 0.0057).

Conclusion: Quetiapine use was associated with a highly significant improvement in functioning; however, it came at a 52% increase in medicine cost. Pre-quetiapine treatments, though, did not achieve an optimal level of functioning, and overall costs may be reduced by more rational prescribing habits.


Keywords

Quetiapine; Bipolar Disorder

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