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Second-generation antipsychotics: cost-effectiveness, policy options, and political decision making
Robert A Rosenheck1, Douglas L Leslie, Jalpa A Doshi
1Department of Psychiatry, Yale Medical School, New Haven, CT 06516, USA. robert.rosenheck@yale.edu
Psychiatric Services (Washington, D.C.)
|May 3, 2008
Summary
Second-generation antipsychotics offer limited advantages over older drugs, failing to justify their high cost. Policy changes could improve cost-effectiveness by promoting selective prescribing of these expensive medications.
Area of Science:
- Pharmacoeconomics
- Psychiatry
- Health Policy
Background:
- Recent research, including the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE), indicates that second-generation antipsychotics (SGAs) offer minimal benefits over first-generation antipsychotics (FGAs).
- This lack of significant advantage is particularly noted for intermediate-potency FGAs, questioning the value proposition of newer agents.
Purpose of the Study:
- To evaluate the cost-effectiveness of second-generation antipsychotics in light of their clinical efficacy compared to first-generation antipsychotics.
- To explore policy interventions for managing the high annual expenditure on SGAs.
Main Methods:
- Analysis of clinical trial data comparing efficacy of SGAs and FGAs.
- Economic evaluation of SGA costs versus demonstrated benefits.
- Review of potential policy interventions for drug cost containment.
Main Results:
- Second-generation antipsychotics, excluding clozapine, provide few demonstrable advantages over first-generation antipsychotics, failing to justify their substantial annual cost of $11.5 billion.
- Current policy environments and stakeholder opposition hinder cost-containment strategies, such as selective prescribing or price regulation.
Conclusions:
- High expenditures on second-generation antipsychotics are likely to persist without significant public health gains.
- Policy interventions are needed to improve the cost-effectiveness of antipsychotic prescribing, balancing access with economic considerations.
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