Cost and outcome implications of using typical and atypical antipsychotics in ordinary practice in Italy

It is uncertain whether atypical antipsychotic agents, as prescribed in ordinary practice, are a cost-effective alternative to conventional agents. This study examined the financial and clinical implications of using atypical antipsychotics in the context of community psychiatric care in Italy.

Service costs and outcome data over a 24-month period (June-November 1999 to June-November 2001) were compared between 2 cohorts of ICD-10-diagnosed subjects, the first including patients receiving atypical and the second typical antipsychotics, according to the type of treatment received at the beginning of the study.

At baseline, 183 subjects were under treatment with antipsychotic drugs, of whom 73 were treated with atypical agents. Most patients had a diagnosis of schizophrenia and only a minority were first-contact patients. Conventional antipsychotics were used in more chronic and elderly patients, while atypicals were prescribed in more severe and recently diagnosed cases. After background group differences were controlled for, the use of atypical agents was neither predictive of higher total health care costs nor of better patient outcome. Predictors of higher costs and better outcome were severity of illness at baseline and first-contact patients.

The introduction of atypical agents had a small impact in terms of total health care costs and outcome, and more important than the agent prescribed was the severity of illness.