Pharmacoeconomic Evaluation of Antipsychotic Therapy for Schizophrenia

Medications comprise a minor portion of the costs of schizophrenia, but may have a major impacton the likelihood of successful outcome of care. Novel antipsychotic medications which demonstratesuperior symptom control, an improved safety profile, and benefits to quality-of-life may also reducepatients’ need for medical services and the associated costs of these treatments. This report first considerskey experimental design elements involved in integrating pharmacoeconomic and clinical objectivesin studies of new drug therapies for schizophrenia. We briefly discuss the choice of therapiesfor comparison, randomization and blinding, sample size and composition, data collection, selectionof the time frame for economic evaluation, and the importance of an intent-to-treat perspective. Second,as an example we present the design and selected results from a new economic clinical trial of thenovel antipsychotic olanzapine. This trial utilized a randomized, double-blind design to compare theuse of medical services and the cost of treatment for 817 schizophrenic patients from the United Statestreated with olanzapine or haloperidol. In comprehensive health care cost comparisons that incorporatedthe expenditures for study medications, the total cost of health care for olanzapine-treated patientswas reduced by an average of $431 per month in comparison with haloperidol-treated patientsduring the initial 6 weeks of treatment. Among treatment responders receiving double-blind therapyfor a maximum of 1 year, the total cost of care among olanzapine responders was reduced by an averageof $345 per month in comparison with haloperidol responders. The results of this economic evaluationsuggest that olanzapine’s superior treatment profile may lead to reductions in the overall costs ofmedical care for patients with schizophrenia.