RESUMO
BACKGROUND: Antipsychotic medications are the primary treatment for schizophrenia, with olanzapine being an effective medication for schizophrenia. The economic cost for each individual with schizophrenia is high, with antipsychotic medication being a major expense. This study aims to develop an economic decision model that compares different treatment options for schizophrenia patients, including olanzapine Orally Dispersible Tablets (ODT), olanzapine [ODT + Standard Oral Tablet (SOT)], risperidone (ODT + SOT), and aripiprazole (ODT + SOT), to determine their cost-effectiveness with an objective to optimize healthcare resource allocation in Morocco. METHODS: The study used published medical literature and a clinical expert panel to develop a decision analytic model. This model was designed to capture parameters such as adherence levels, treatment discontinuation, relapse with and without hospitalization, quality-adjusted life years (QALYs), treatment-related adverse events, healthcare resource utilization, and associated costs. The main outcomes of interest included the total annual direct cost per treatment, QALYs, and incremental cost-effectiveness ratio (ICER) per 1 QALY gained. One-way and probabilistic sensitivity analyses were employed to account for parameter uncertainty. RESULTS: According to the simulation model, the ODT and ODT + SOT as a group form of olanzapine was the most effective treatment option in terms of the lowest percentages of inpatient relapse, and patients who remained stable (11% and 79% respectively) than risperidone (19% and 62% respectively) and aripiprazole ODT (26% and 50% respectively) and ODT + SOT formulation groups. Olanzapine (ODT + SOT) therapy group was cost-effective when compared to the combined group of ODT + SOT forms of risperidone [ICER: Moroccan Dirham (MAD) 103,907], and aripiprazole (ICER: MAD 65,047). Additionally, olanzapine ODT was found to be cost-effective compared to olanzapine SOT with an ICER of MAD 3921, risperidone ODT with an ICER of MAD 1,02,298, risperidone SOT with an ICER of MAD 31,088, and aripiprazole ODT or SOT formulations. All the above ICERs fall under the willingness-to-pay threshold in Morocco of MAD 250,832.40. Sensitivity analyses confirmed the reliability of the findings. CONCLUSIONS: The model concluded that olanzapine ODT is the most cost-effective first-line treatment option for schizophrenia in Morocco when compared to other atypical antipsychotic medications in ODT and SOT formulations.
RESUMO
Research on lemon grass (Cymbopogon citratus L.) revealed a variety of active molecules and examined their biological characteristics. However, most of these studies were conducted on wild varieties, while cultivated plants were addressed less. This study aimed to characterize the biomolecules and biological activities of lemon grass growing under North African conditions in Morocco. Phenolic compound profiles of aqueous (AE), ethanol (EE), and methanol (ME) extracts and their fractions were obtained with steric exclusion chromatography on Sephadex G50 gel and identified by LC-MS/MS. Then, total polyphenols (TPC), flavonoids (TFC), and antioxidant activities (FRAP: scavenging value and TAC: Total Antioxidant Capacity) of the fraction were evaluated, as well as the antimicrobial activity. The obtained results showed that the ME contained eight major compounds (i.e., apigenine-7-O-rutinoside and myricitine-3-O-rutinoside). The AE showed the presence of five molecules (i.e., kaempferol-3-O-glucuronide), while EE showed the presence of three molecules (i.e., quercetine-3-O-rutinoside). Regarding the chemical characterization, the highest value of total phenolic content (TPC) was obtained in AE (25) (4.60 ± 0.29 mg/g), and the highest value of total flavonoid content (TFC) was obtained in ME (29) (0.7 ± 0.08 mg/g). Concerning the antioxidant activity, the highest FRAP was obtained in ME (29) (97.89%), and the highest total antioxidant capacity (TAC) was obtained in ME (29) (89.89%). Correlation between FRAP, TPC, and TFC was noted only in fractions of AE and ME. All tested extracts of C. citratus and their fractions showed a significant antimicrobial effect. The lowest minimum inhibitory concentration (MIC) was recorded for ME against E. coli. Extracts' biological activities and their fractions were governed by their active molecules. These data are new and clarify a novel aspect of bioactive molecules in the extracts of cultivated C. citratus. Equally, throughout this research, we clarified the relationship between identified molecules and their biological properties, including antioxidant and anti-microbial activities, which is new for the study area. This study is suggested as a reference for comparative studies and other assays of other biological activities for the study plant.