Cost-effectiveness of first-<i>v.</i>second-generation antipsychotic drugs: results from a randomised controlled trial in schizophrenia responding poorly to previous therapy

Davies, Linda; Lewis, Shôn; Jones, Peter B.; Barnes, Thomas R. E.; Gaughran, Fiona; Hayhurst, Karen P.; Markwick, Alison; Lloyd, Helen

doi:10.1192/bjp.bp.106.028654

Cited by 93 publications

(51 citation statements)

References 34 publications

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“…6 Antipsychotic drug costs accounted for only a small proportion of total costs (2.1% in the FGA arm and 3.8% in the SGA arm). The major costs in both groups were from psychiatric hospital inpatient admissions (93.2% and 81.5% of total costs in the FGA and SGA arms, respectively).…”

Section: Cost-effectivenessmentioning

confidence: 99%

Antipsychotics and Schizophrenia: From Efficacy and Effectiveness to Clinical Decision-Making

Foussias

Remington

2010

Can J Psychiatry

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Objective: To comprehensively review the 2 recent and large antipsychotic effectiveness trials for treatment of schizophrenia: the United Kingdom's Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS), and the National Institute of Mental Health-initiated Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial. Method: We present a review of the rationale, methodology, and findings to date from the CUtLASS and CATIE schizophrenia trials, including all primary and secondary outcomes. Results: The primary findings from both trials, CUtLASS and CATIE, suggest that first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs) are equally effective in the treatment of schizophrenia. The exception is in treatment-resistant populations where clozapine exhibits superiority, compared with other SGAs. In the CATIE trial, there is a suggestion that olanzapine is superior in effectiveness, compared with other nonclozapine SGAs, although this seems to be mediated by past history of olanzapine use, and carries with it increased weight gain and metabolic adverse events. From a cost-effectiveness perspective, there is no evidence that SGAs are superior to FGAs, with findings suggesting the possibility that FGAs may be superior. Conclusion: Past efficacy trials have strongly supported the position that SGAs are superior to FGAs in the treatment of schizophrenia and in side effect profile. Two large independent effectiveness trials, CUtLASS and CATIE, have offered a strong challenge to these claims. Both suggest that SGAs, except clozapine in the treatment-resistant population, offer little, if any, clinical benefits, and, moreover, harbour their own significant side effects.

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Section: Cost-effectivenessmentioning

confidence: 99%

Antipsychotics and Schizophrenia: From Efficacy and Effectiveness to Clinical Decision-Making

Foussias

Remington

2010

Can J Psychiatry

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“…CATIE, cost utility of the latest antipsychotic drugs in schizophrenia study and the treatment of early onset schizophrenia spectrum disorders studies found the SGA not to be cost-effective. 42,44,45,46 These efficacy differences are controversial but there is good agreement that clozapine is more effective e than all the other SGA.…”

Section: Some Other Significant Advances Following Chlorpromazinementioning

confidence: 99%

Another view of the history of antipsychotic drug discovery and development

Carpenter

Davis

2012

Mol Psychiatry

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Chlorpromazine initiated effective pharmacotherapy for schizophrenia 60 years ago. This discovery initiated or stimulated key developments in the field of psychiatry. Nonetheless, advances in pharmacotherapy of schizophrenia have been modest. Psychosis remains the primary aspect of psychopathology addressed, and core pathologies such as cognition and negative symptom remain unmet therapeutic challenges. New clinical and basic neuroscience paradigms may guide the near future and provide a more heuristic construct for novel and innovative discovery.

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“…The CUtLASS trial comparing atypical (second-generation) and typical (first-generation) antipsychotics used the QALY as the primary variable in the economic evaluation (Davies et al, 2007). In contrast, de Willige et al (2005) were not positive about the performance of the EQ-5D after assessing the sensitivity and validity of EQ-5D for measuring changes in the quality of life of patients with chronic schizophrenia.…”

Section: Using Qalys In Mental Health Researchmentioning

confidence: 99%

“The trouble with QALYs…”

Knapp¹,

Mangalore²

2007

Epidemiol Psychiatr Sci

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Abstract. This paper summarises the use of QALYs in evaluating changes in mental health states, highlighting the benefits and challenges of their use in this field. The general principles underlying the QALY measure and the most common methods of measuring QALYs are discussed briefly. Evidence of the usefulness and problems of using this generic measure of health-related quality of life are provided from a sample of recent studies relating to depression, schizophrenia, attention deficit hyperactivity disorder and dementia. In each case, attempts were made to use QALYs to measure changes in health states. While in principle, the QALY is enormously attractive, its suitability for measuring changes in many mental health conditions remains open to doubt as existing tools for generating QALY scores such as the EQ-5D have tended not to perform sufficiently well in reflecting changes in many mental health states. New developmental work is needed to construct better QALY-measuring tools for use in the mental health field. Both the conceptualisation and measurement of QALYs need to be built on a valid, comprehensive model of quality of life specific to a mental health disorder, to ensure that the resultant tool is sensitive enough to pick up changes that would be expected and seen as relevant in the course of the illness. CHOOSING BETWEEN ALTERNATIVESObviously, the main aims of a mental health system are to alleviate symptoms and improve quality of life, but it is widely appreciated that regard must also be paid to the economic consequences of the treatments and support arrangements that are offered. One consequence has been the growing attention paid to the cost-effectiveness as well as the effectiveness of health care interventions. The underlying reason is scarcity: there are insufficient resources to meet all of a society's needs or demands, and so difficult choices have to be made between competing uses of those resources. In particular, decision makers with responsibility for allocating resources must weigh up the outcomes achieved in those various different uses of resources and the costs of achieving them. This is quite a challenge when the outcomes are measured in different ways. How, for example, is a decision maker to compare cancer treatment with a psychological intervention for depression or a health promotion campaign to reduce coronary heart disease? HEALTH ECONOMIC EVALUATIONS -BROADENING OUTWhen a new treatment is developed or introduced decision makers face two central questions. The clinical question is whether the intervention (say a new antidepressant) is more effective than existing interventions in alleviating depressive symptoms and generally improving health and quality of life. If the answer to the clinical question is that the new medication is no better than existing options, then there is usually no need to consider its use any further. But if it looks clinically effective, the decision maker will then want an answer to a second question: is it cost-effective? That is, does the treatment ach...

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Cost-effectiveness of first-v.second-generation antipsychotic drugs: results from a randomised controlled trial in schizophrenia responding poorly to previous therapy

Abstract: The primary and sensitivity analyses indicated that conventional antipsychotics may be cost-saving and associated with a gain in QALYs compared with atypical antipsychotics.

Cited by 93 publications

References 34 publications

Antipsychotics and Schizophrenia: From Efficacy and Effectiveness to Clinical Decision-Making

Antipsychotics and Schizophrenia: From Efficacy and Effectiveness to Clinical Decision-Making

Another view of the history of antipsychotic drug discovery and development

“The trouble with QALYs…”

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