Changing environments and alternative perspectives in evaluating the cost-effectiveness of new antipsychotic drugs

Robert Rosenheck, Jefferson Doyle, Douglas Leslie, Alan Fontana

Research output: Contribution to journalReview article

20 Citations (Scopus)

Abstract

This article examines the ways in which changes in the treatment environment and in measurement perspectives can affect the evaluation of cost-effectiveness of new medications. In three studies we reexamined data from a clinical trial of haloperidol and clozapine conducted from 1993 to 1996. The results of the studies are as follows: Study 1 found that clozapine treatment was associated with significantly reduced inpatient costs, and increased outpatient costs, suggesting that as systems use less inpatient care and more outpatient care, more effective medications may increase, rather than decrease, costs in sicker patients. Study 2 found that while provider assessments and standard measures favored clozapine over haloperidol, patient responses showed little evidence of a clinical advantage for clozapine and a less favorable side-effect profile. Study 3 found that while annual drug costs in the published trial were estimated to be $4,545 for a full year of clozapine treatment, atypical antipsychotic costs in 2000 were estimated to range from $1,254 to $3,016 in the Department of Veterans Affairs system, and from $2,221 to $8,147 in the private sector. In conclusion, cost-effectiveness, as evaluated in studies like CATIE, will increasingly need to be tied to service system contingencies, environments, and evaluation perspectives.

Original languageEnglish (US)
Pages (from-to)81-93
Number of pages13
JournalSchizophrenia Bulletin
Volume29
Issue number1
DOIs
StatePublished - Jan 1 2003

Fingerprint

Clozapine
Antipsychotic Agents
Cost-Benefit Analysis
Costs and Cost Analysis
Haloperidol
Inpatients
Drug Costs
Private Sector
Veterans
Ambulatory Care
Outpatients
Therapeutics
Clinical Trials

All Science Journal Classification (ASJC) codes

  • Psychiatry and Mental health

Cite this

@article{42f8ee06ca1b435d9c1789245d33931e,
title = "Changing environments and alternative perspectives in evaluating the cost-effectiveness of new antipsychotic drugs",
abstract = "This article examines the ways in which changes in the treatment environment and in measurement perspectives can affect the evaluation of cost-effectiveness of new medications. In three studies we reexamined data from a clinical trial of haloperidol and clozapine conducted from 1993 to 1996. The results of the studies are as follows: Study 1 found that clozapine treatment was associated with significantly reduced inpatient costs, and increased outpatient costs, suggesting that as systems use less inpatient care and more outpatient care, more effective medications may increase, rather than decrease, costs in sicker patients. Study 2 found that while provider assessments and standard measures favored clozapine over haloperidol, patient responses showed little evidence of a clinical advantage for clozapine and a less favorable side-effect profile. Study 3 found that while annual drug costs in the published trial were estimated to be $4,545 for a full year of clozapine treatment, atypical antipsychotic costs in 2000 were estimated to range from $1,254 to $3,016 in the Department of Veterans Affairs system, and from $2,221 to $8,147 in the private sector. In conclusion, cost-effectiveness, as evaluated in studies like CATIE, will increasingly need to be tied to service system contingencies, environments, and evaluation perspectives.",
author = "Robert Rosenheck and Jefferson Doyle and Douglas Leslie and Alan Fontana",
year = "2003",
month = "1",
day = "1",
doi = "10.1093/oxfordjournals.schbul.a006994",
language = "English (US)",
volume = "29",
pages = "81--93",
journal = "Schizophrenia Bulletin",
issn = "0586-7614",
publisher = "Oxford University Press",
number = "1",

}

Changing environments and alternative perspectives in evaluating the cost-effectiveness of new antipsychotic drugs. / Rosenheck, Robert; Doyle, Jefferson; Leslie, Douglas; Fontana, Alan.

In: Schizophrenia Bulletin, Vol. 29, No. 1, 01.01.2003, p. 81-93.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Changing environments and alternative perspectives in evaluating the cost-effectiveness of new antipsychotic drugs

AU - Rosenheck, Robert

AU - Doyle, Jefferson

AU - Leslie, Douglas

AU - Fontana, Alan

PY - 2003/1/1

Y1 - 2003/1/1

N2 - This article examines the ways in which changes in the treatment environment and in measurement perspectives can affect the evaluation of cost-effectiveness of new medications. In three studies we reexamined data from a clinical trial of haloperidol and clozapine conducted from 1993 to 1996. The results of the studies are as follows: Study 1 found that clozapine treatment was associated with significantly reduced inpatient costs, and increased outpatient costs, suggesting that as systems use less inpatient care and more outpatient care, more effective medications may increase, rather than decrease, costs in sicker patients. Study 2 found that while provider assessments and standard measures favored clozapine over haloperidol, patient responses showed little evidence of a clinical advantage for clozapine and a less favorable side-effect profile. Study 3 found that while annual drug costs in the published trial were estimated to be $4,545 for a full year of clozapine treatment, atypical antipsychotic costs in 2000 were estimated to range from $1,254 to $3,016 in the Department of Veterans Affairs system, and from $2,221 to $8,147 in the private sector. In conclusion, cost-effectiveness, as evaluated in studies like CATIE, will increasingly need to be tied to service system contingencies, environments, and evaluation perspectives.

AB - This article examines the ways in which changes in the treatment environment and in measurement perspectives can affect the evaluation of cost-effectiveness of new medications. In three studies we reexamined data from a clinical trial of haloperidol and clozapine conducted from 1993 to 1996. The results of the studies are as follows: Study 1 found that clozapine treatment was associated with significantly reduced inpatient costs, and increased outpatient costs, suggesting that as systems use less inpatient care and more outpatient care, more effective medications may increase, rather than decrease, costs in sicker patients. Study 2 found that while provider assessments and standard measures favored clozapine over haloperidol, patient responses showed little evidence of a clinical advantage for clozapine and a less favorable side-effect profile. Study 3 found that while annual drug costs in the published trial were estimated to be $4,545 for a full year of clozapine treatment, atypical antipsychotic costs in 2000 were estimated to range from $1,254 to $3,016 in the Department of Veterans Affairs system, and from $2,221 to $8,147 in the private sector. In conclusion, cost-effectiveness, as evaluated in studies like CATIE, will increasingly need to be tied to service system contingencies, environments, and evaluation perspectives.

UR - http://www.scopus.com/inward/record.url?scp=0038487333&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0038487333&partnerID=8YFLogxK

U2 - 10.1093/oxfordjournals.schbul.a006994

DO - 10.1093/oxfordjournals.schbul.a006994

M3 - Review article

C2 - 12908663

AN - SCOPUS:0038487333

VL - 29

SP - 81

EP - 93

JO - Schizophrenia Bulletin

JF - Schizophrenia Bulletin

SN - 0586-7614

IS - 1

ER -