Pharmacoeconomic evaluation of antipsychotic therapy for schizophrenia

Medications comprise a minor portion of the costs of schizophrenia, but may have a major impact on the likelihood of successful outcome of care. Novel antipsychotic medications which demonstrate superior symptom control, an improved safety profile, and benefits to quality-of-life may also reduce patients' need for medical services and the associated costs of these treatments. This report first considers key experimental design elements involved in integrating pharmacoeconomic and clinical objectives in studies of new drug therapies for schizophrenia. We briefly discuss the choice of therapies for comparison, randomization and blinding, sample size and composition, data collection, selection of 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 the novel antipsychotic olanzapine. This trial utilized a randomized, double-blind design to compare the use of medical services and the cost of treatment for 817 schizophrenic patients from the United States treated with olanzapine or haloperidol. In comprehensive health care cost comparisons that incorporated the expenditures for study medications, the total cost of health care for olanzapine-treated patients was reduced by an average of $431 per month in comparison with haloperidol-treated patients during the initial 6 weeks of treatment. Among treatment responders receiving double-blind therapy for a maximum of 1 year, the total cost of care among olanzapine responders was reduced by an average of $345 per month in comparison with haloperidol responders. The results of this economic evaluation suggest that olanzapine's superior treatment profile may lead to reductions in the overall costs of medical care for patients with schizophrenia.