Second-generation antipsychotics: cost-effectiveness, policy options, and political decision making

The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) and other recent research suggest that second-generation antipsychotics other than clozapine may offer few, if any, advantages over first-generation antipsychotics, especially agents of intermediate potency. Thus the newer agents are not likely to generate sufficient benefit to justify their $11.5 billion annual cost. Policy approaches for containing drug costs are available and could improve cost-effectiveness by encouraging that second-generation antipsychotics be prescribed more selectively, such as only when clearly indicated. However, restrictions on either drug availability or physician choice are vigorously opposed by professional and consumer advocacy groups as well as by industry, and excessively restrictive approaches could unintentionally reduce access to beneficial treatments. Interventions that directly reduce second-generation antipsychotic prices would increase access for consumers but are inconsistent with broad opposition to government price regulation in the United States. High expenditures on these medications are thus likely to continue without concomitant gains for public health.