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Tizanidine average cost of $4.3, whereas the tizanidine 30 cost median cost was $5.3, which nearly twice as much that of tizanidine (median cost $2.9). In addition, the mean cost of citalopram plus zoloft was $1.9 ($0.6–2.1) compared with $4.3 for citalopram alone and $2 zoloft/citalopram combination. In the United States, total cost of taking the meds, such as tizanidine, averaged $21,664, which represents 5.7% of the total US expenditure for all health care in 1999. The mean cost for medications was $15,976. In addition, the cost of hospitalizations was significantly higher for the meds ($17,622) compared with placebo ($7,200) Zanaflex (tizanidine) - the drug with an antispastic effect in increased muscle tone, relieves spasms and clonic convulsions. Assign with painful muscular spasms associated with static and functional spine lesions (cervical and lumbar syndrome), and after surgery for a herniated disc or osteoarthritis of the thigh, as well as for spasms and pain due to multiple sclerosis, chronic myelopathy, degenerative diseases of the spinal cord brain, stroke, with cramps of central origin. (adjusted cost difference, $17,622 to $7,200 for a 1.7% cost decrease). To calculate the median cost of all medicines we used the median price of all medications given in 1998–1999 with prices on the year of first pharmacy visit before the medication was dispensed (1 = lowest, 2 next highest). The mean of all pharmaceutical prices was multiplied by 2.24 in order to obtain the mean price of all meds within the same class of medications. To calculate the total cost of treatment bipolar disorder as a percentage of overall US healthcare, we divided the meds price into total US spending for health care in 1999, as given the US Statistical Abstract of 1999.16 In addition, the total cost of treatment had the mean price divided by median for the medication given in 1998–1999 (1 = lowest, 2 next lowest). To do so we used the US Bureau of Labor Statistics Consumer Price Index from 1999 by the consumer cost index calculator at the US Bureau of Labor Statistics.16 All medicines were divided into four groups: the first category was medications that were given as prescribed, the rest were ones purchased off-patent, the last two were new pharmaceuticals from the market. In total we divided the medications into three classes: first category were used off patent medications and most of these had a medico-economic median price of $13,500 and above. The second category comprised generics that had a medicoeconomic median price between $20,000 and $30,000. The third class comprised those medications which were medicated through off-the-shelf pharmaceutical companies, for a medicoeconomic median price of $5,000 or less. Lastly, the fourth class is that which was the medications provided under a research project by large pharmaceutical company. These medications were not marketed, sold or approved by the US Food and Drug Administration, although they were administered through clinical trials at the FDA-approved company or research institutes. We also calculated the medicoeconomic median price by manufacturer across all medication manufacturers, as reported in the FDA Summary of Product Characteristics, from 1999–2000.16 Methods In order to calculate the proportion of individuals who require medications, we used the population of US citizens (aged 8 years [median age, 12 years]) who reported using antidepressants over the previous 12 months in a response to the US Census of Population by race/ethnicity in 2002.17 The number of US residents who reported their medication usage in 2002 was 15,300,000, so we could calculate our medication proportion of the US population by multiplying number of people reporting using an antidepressant to get at the medication demand of US population. We calculated our medication proportion by calculating the medicoeconomic median price of medications (median drug prices, defined as the median price paid by first-priced drug, over time and each thereafter at the same price) across all medications dispensed by a pharmacy in month. We divided this medicoeconomic median price by total monthly revenue in order to obtain the median medicoeconomic proportion across patients dispensed medications that month. We used SAS version 8.2 software (SAS Institute, Cary, North Carolina) to perform the analyses. For each of medicoeconomic variables we used the following assumptions in order to calculate medicoeconomic median price and to obtain a medicoeconomic proportion: the percentage of all meds dispensed to patients whose medicoeconomic median pricing was above the corresponding percentage; median medicoeconomic proportion of the drug market as a whole (medicoeconomic median drug prices); the average price of an over-the-counter medications; the average price charged for a generic in the country; and average cost paid by the patient for prescriptions dispensed. To compute medicoeconomic mean price we assumed a medicoeconomic median price of $5.25. In order to calculate medicoeconomic mean price in the first part of study, which represented the medico.
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